NPI: 1043525140 · BELLEVILLE, IL 62223 · General Practice Dentistry · NPI assigned 08/12/2010
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 1,642 | $63K |
| 2019 | 20 | $2K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0999 | Unspecified diagnostic procedure, by report | 582 | 522 | $65K |
| D0272 | Bitewings - two radiographic images | 174 | 172 | $0.00 |
| D1206 | Topical application of fluoride varnish | 290 | 290 | $0.00 |
| D0150 | Comprehensive oral evaluation - new or established patient | 43 | 43 | $0.00 |
| D0120 | Periodic oral evaluation - established patient | 227 | 227 | $0.00 |
| D1120 | Prophylaxis - child | 296 | 296 | $0.00 |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 50 | 42 | $0.00 |