OAK TREE FAMILY DENTISTRY LLC
NPI: 1003175761
· GRETNA, LA 70053
· General Practice Dentistry
· NPI assigned 05/15/2012
$192K
Total Medicaid Paid
Provider Details
| Authorized Official | NGUYEN, CUONG (MANAGER) |
| NPI Enumeration Date | 05/15/2012 |
Related Entities
Other providers sharing the same authorized official: NGUYEN, CUONG
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,109 |
$37K |
| 2019 |
1,036 |
$34K |
| 2020 |
859 |
$30K |
| 2021 |
1,180 |
$40K |
| 2022 |
1,119 |
$30K |
| 2023 |
431 |
$10K |
| 2024 |
303 |
$10K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,438 |
1,386 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,156 |
2,075 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
689 |
679 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,016 |
983 |
$19K |
| D1120 |
Prophylaxis - child |
358 |
355 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
135 |
130 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
28 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
102 |
99 |
$967.07 |
| D0230 |
Intraoral - periapical each additional radiographic image |
88 |
56 |
$865.12 |