LAKE MOULTRIE DENTAL LLC
NPI: 1013482603
· MONCKS CORNER, SC 29461
· Dental Clinic/Center
· NPI assigned 10/10/2018
Provider Details
| Authorized Official | JAQUES, BRIAN (OWNER/DENTIST) |
| NPI Enumeration Date | 10/10/2018 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
49 |
$2K |
| 2021 |
87 |
$2K |
| 2022 |
169 |
$6K |
| 2023 |
245 |
$7K |
| 2024 |
53 |
$2K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
209 |
209 |
$10K |
| D0274 |
Bitewings - four radiographic images |
180 |
180 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
118 |
118 |
$3K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$518.55 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$455.40 |
| D0220 |
Intraoral - periapical first radiographic image |
34 |
33 |
$438.77 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
26 |
$270.42 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$194.40 |