NPI: 1063954139 · CLINTON, AR 72031 · Dentist · NPI assigned 11/07/2016
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 148 | $4K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 28 | 28 | $1K |
| D0272 | Bitewings - two radiographic images | 35 | 35 | $864.50 |
| D1208 | Topical application of fluoride, excluding varnish | 39 | 39 | $778.05 |
| D1110 | Prophylaxis - adult | 13 | 13 | $629.85 |
| D0120 | Periodic oral evaluation - established patient | 14 | 14 | $372.40 |
| D0602 | 19 | 19 | $95.00 |