PORTLAND DENTAL SMILES
NPI: 1063065068
· PORTLAND, OR 97205
· Dental Clinic/Center
· NPI assigned 07/18/2019
$747.00
Total Medicaid Paid
Provider Details
| Authorized Official | DEWOLF, CAMILLE (OFFICE MANAGER) |
| NPI Enumeration Date | 07/18/2019 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2024 |
108 |
$747.00 |
Billing Codes
| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
16 |
16 |
$235.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$190.00 |
| D0120 |
Periodic oral evaluation - established patient |
18 |
18 |
$112.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$87.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$57.00 |
| D0220 |
Intraoral - periapical first radiographic image |
20 |
20 |
$39.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
14 |
$27.00 |