MODERN FAMILY DENTAL PC
NPI: 1003479833
· GRAND HAVEN, MI 49417
· General Practice Dentistry
· NPI assigned 04/17/2019
$410.15
Total Medicaid Paid
Provider Details
| Authorized Official | HEISE, RENEE (INSURANCE SPECIALIST) |
| NPI Enumeration Date | 04/17/2019 |
Related Entities
Other providers sharing the same authorized official: HEISE, RENEE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
24 |
$410.15 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$220.26 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$189.89 |