HART FAMILY DENTSTRY
NPI: 1033545892
· MITCHELL, SD 57301
· Dentist
· NPI assigned 09/24/2013
$743.90
Total Medicaid Paid
Provider Details
| Authorized Official | HART, KARISA (OWNER) |
| NPI Enumeration Date | 09/24/2013 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
28 |
$743.90 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$435.15 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$308.75 |