LEGENDARY SMILES, P.C.
NPI: 1023463320
· WATFORD CITY, ND 58854
· Dental Clinic/Center
· NPI assigned 04/25/2016
Provider Details
| Authorized Official | BULZOMI, MONTY (OWNER/DENTIST) |
| NPI Enumeration Date | 04/25/2016 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
64 |
$2K |
| 2019 |
64 |
$2K |
| 2020 |
17 |
$316.08 |
| 2021 |
99 |
$3K |
| 2022 |
146 |
$4K |
| 2023 |
67 |
$2K |
| 2024 |
13 |
$432.25 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
192 |
175 |
$5K |
| D1206 |
Topical application of fluoride varnish |
209 |
190 |
$5K |
| D1120 |
Prophylaxis - child |
55 |
52 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$627.39 |