NPI: 1053054304 · BERWYN, IL 60402 · Student in an Organized Health Care Education/Training Program · NPI assigned 04/14/2022
| Year | Claims | Total Paid |
|---|---|---|
| 2023 | 81 | $2K |
| 2024 | 51 | $2K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1206 | Topical application of fluoride varnish | 48 | 44 | $979.93 |
| D1110 | Prophylaxis - adult | 16 | 12 | $806.65 |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 24 | 15 | $495.20 |
| D0120 | Periodic oral evaluation - established patient | 15 | 14 | $382.20 |
| D1120 | Prophylaxis - child | 12 | 12 | $379.50 |
| D0220 | Intraoral - periapical first radiographic image | 17 | 12 | $96.73 |