SOUTHCENTRAL FOUNDATION
NPI: 1013464916
· NONDALTON, AK 99640
· General Practice Dentistry
· NPI assigned 09/08/2016
$153K
Total Medicaid Paid
Provider Details
| Authorized Official | OLSON, LEE (EXECUTIVE VICE PRESIDENT FINANCE) |
| Parent Organization | SOUTHCENTRAL FOUNDATION |
| NPI Enumeration Date | 09/08/2016 |
Related Entities
Other providers sharing the same authorized official: OLSON, LEE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
132 |
$35K |
| 2019 |
106 |
$38K |
| 2020 |
12 |
$0.00 |
| 2021 |
35 |
$12K |
| 2022 |
74 |
$12K |
| 2023 |
100 |
$26K |
| 2024 |
88 |
$30K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
187 |
165 |
$99K |
| D1206 |
Topical application of fluoride varnish |
270 |
248 |
$34K |
| D1120 |
Prophylaxis - child |
63 |
62 |
$20K |
| D0603 |
|
27 |
27 |
$0.00 |