BAUER-MONDRAGON, TAMARA
NPI: 1013119890
· MASON, MI 48854
· General Practice Dentistry
· NPI assigned 06/04/2007
$664.00
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
12 |
$300.00 |
| 2019 |
13 |
$364.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$364.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$300.00 |