NPI: 1013352863 · GALVESTON, TX 77551 · Dentist · NPI assigned 05/07/2013
| Year | Claims | Total Paid |
|---|---|---|
| 2022 | 125 | $2K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 15 | 15 | $551.25 |
| D0120 | Periodic oral evaluation - established patient | 19 | 19 | $548.15 |
| D0230 | Intraoral - periapical each additional radiographic image | 37 | 17 | $425.87 |
| D1206 | Topical application of fluoride varnish | 16 | 16 | $235.20 |
| D0220 | Intraoral - periapical first radiographic image | 17 | 17 | $213.52 |
| D0602 | 21 | 21 | $0.00 |