DYCKMAN DENTAL ARTS,PC

NPI: 1033408174 · NEW YORK, NY 10040 · General Practice Dentistry · NPI assigned 03/29/2011

$102K

Total Medicaid Paid

6,167

Total Claims

6,148

Beneficiaries

Codes Billed

2018-01

First Month

2019-04

Last Month

Provider Details

Authorized Official	HUBSCHER, SHAUL (PRESIDENT)
NPI Enumeration Date	03/29/2011

Other providers sharing the same authorized official: HUBSCHER, SHAUL

Provider	City	State	Total Paid
COMFORT DENTAL CARE PLLC	BRONX	NY	$2.57M
125TH STREET DENTAL ARTS P.C.	NEW YORK	NY	$2.02M
SH GENTLE DENTAL PC	NEW YORK	NY	$650K
DR DANA DENTAL & CO. P.C.	NEW YORK	NY	$133K
INWOOD DENTAL ASSOCIATES, P.C.	NEW YORK	NY	$86K
PEAR DENTAL PC	NEW YORK	NY	$82K

Year	Claims	Total Paid
2018	4,999	$83K
2019	1,168	$19K

Code	Description	Claims	Beneficiaries	Total Paid
D1110	Prophylaxis - adult	887	885	$29K
D0120	Periodic oral evaluation - established patient	1,207	1,205	$23K
D0230	Intraoral - periapical each additional radiographic image	1,236	1,234	$13K
D0210	Intraoral - complete series of radiographic images	816	812	$12K
D0220	Intraoral - periapical first radiographic image	1,274	1,268	$11K
D1120	Prophylaxis - child	198	198	$6K
D1208	Topical application of fluoride, excluding varnish	342	342	$4K
D2391	Resin-based composite - one surface, posterior, primary or permanent	72	69	$3K
D0272	Bitewings - two radiographic images	90	90	$1K
D0150	Comprehensive oral evaluation - new or established patient	16	16	$304.00
D0140	Limited oral evaluation - problem focused	29	29	$217.30