MAIN STREET DENTAL
NPI: 1043557085
· SOUTHAVEN, MS 38671
· Dentist
· NPI assigned 01/10/2013
Provider Details
| Authorized Official | BRADDY, JARAD (MEMBER) |
| NPI Enumeration Date | 01/10/2013 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,323 |
$4K |
| 2019 |
684 |
$5K |
| 2020 |
292 |
$3K |
| 2021 |
12 |
$517.90 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
525 |
150 |
$4K |
| D1120 |
Prophylaxis - child |
584 |
142 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
327 |
79 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
289 |
53 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
402 |
89 |
$669.86 |
| D0120 |
Periodic oral evaluation - established patient |
95 |
39 |
$644.50 |
| D1206 |
Topical application of fluoride varnish |
89 |
26 |
$618.80 |