NPI: 1073242871 · MORTON GROVE, IL 60053 · General Practice Dentistry · NPI assigned 06/07/2022
| Year | Claims | Total Paid |
|---|---|---|
| 2022 | 36 | $665.00 |
| 2023 | 263 | $7K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 72 | 72 | $3K |
| D0120 | Periodic oral evaluation - established patient | 87 | 87 | $2K |
| D1208 | Topical application of fluoride, excluding varnish | 72 | 72 | $2K |
| D0150 | Comprehensive oral evaluation - new or established patient | 13 | 13 | $339.04 |
| D0274 | Bitewings - four radiographic images | 15 | 15 | $279.16 |
| D0220 | Intraoral - periapical first radiographic image | 21 | 21 | $138.81 |
| D0230 | Intraoral - periapical each additional radiographic image | 19 | 19 | $85.12 |