NPI: 1043982093 · WEST COVINA, CA 91790 · Dental Clinic/Center · NPI assigned 09/29/2021
| Authorized Official | MOE, THOMAS (PRESIDENT) |
| NPI Enumeration Date | 09/29/2021 |
| Year | Claims | Total Paid |
|---|---|---|
| 2023 | 151 | $2K |
| 2024 | 412 | $7K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 35 | 14 | $2K |
| D0350 | 175 | 54 | $2K | |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 28 | 12 | $2K |
| D1120 | Prophylaxis - child | 26 | 26 | $1K |
| D0230 | Intraoral - periapical each additional radiographic image | 239 | 53 | $1K |
| D1208 | Topical application of fluoride, excluding varnish | 47 | 47 | $664.00 |
| D0272 | Bitewings - two radiographic images | 13 | 13 | $156.00 |