DYNAMIC SMILE DENTAL PLLC
NPI: 1073987301
· NEW YORK, NY 10013
· Dentist
· NPI assigned 11/24/2015
$147K
Total Medicaid Paid
Provider Details
| Authorized Official | LEE, DIANA (SOLE PROPRIETOR) |
| NPI Enumeration Date | 11/24/2015 |
Related Entities
Other providers sharing the same authorized official: LEE, DIANA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
504 |
$13K |
| 2019 |
1,002 |
$22K |
| 2020 |
600 |
$11K |
| 2021 |
1,550 |
$36K |
| 2022 |
1,014 |
$22K |
| 2023 |
1,023 |
$23K |
| 2024 |
787 |
$21K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,544 |
1,537 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
995 |
989 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,005 |
1,004 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,262 |
1,254 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,104 |
1,101 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
25 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
98 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
149 |
149 |
$3K |
| D1999 |
|
242 |
205 |
$0.00 |
| D0707 |
|
14 |
13 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
29 |
24 |
$0.00 |