FIVE-TOWN HEALTH ALLIANCE, INC
NPI: 1013562636
· BRISTOL, VT 05443
· Dentist
· NPI assigned 08/09/2019
$229K
Total Medicaid Paid
Provider Details
| Authorized Official | MELBOSTAD, HEIDI (CHIEF EXECUTIVE OFFICER) |
| Parent Organization | FIVE-TOWN HEALTH ALLIANCE, INC |
| NPI Enumeration Date | 08/09/2019 |
Related Entities
Other providers sharing the same authorized official: MELBOSTAD, HEIDI
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
357 |
$9K |
| 2020 |
379 |
$13K |
| 2021 |
1,115 |
$34K |
| 2022 |
2,610 |
$72K |
| 2023 |
1,172 |
$48K |
| 2024 |
934 |
$53K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,950 |
1,692 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
1,476 |
1,232 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
683 |
512 |
$27K |
| D0274 |
Bitewings - four radiographic images |
523 |
462 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
419 |
302 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
245 |
170 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
49 |
$10K |
| D1206 |
Topical application of fluoride varnish |
627 |
537 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
28 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
350 |
253 |
$5K |
| D1120 |
Prophylaxis - child |
151 |
124 |
$4K |
| D4910 |
|
13 |
13 |
$858.00 |
| D1354 |
|
18 |
12 |
$258.00 |