LE, TIN
NPI: 1023161312
· UNION CITY, CA 94587
· General Practice Dentistry
· NPI assigned 01/19/2007
$283.55
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
46 |
$283.55 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$158.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
15 |
$125.55 |