LARISSA GUSHANSKY, DDS INC.
NPI: 1013102029
· POMONA, CA 91766
· General Practice Dentistry
· NPI assigned 09/12/2007
$0.00
Total Medicaid Paid
Provider Details
Related Entities
Other providers sharing the same authorized official: GUSHANSKY, LARISSA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
50 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$0.00 |