SUMMIT CITY SMILES
NPI: 1083080386
· FORT WAYNE, IN 46805
· Dental Clinic/Center
· NPI assigned 08/20/2015
$114K
Total Medicaid Paid
Provider Details
| Authorized Official | VALLIERE, ROGER (PRESIDENT) |
| NPI Enumeration Date | 08/20/2015 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
122 |
$943.31 |
| 2019 |
396 |
$10K |
| 2020 |
1,001 |
$22K |
| 2021 |
1,396 |
$41K |
| 2022 |
881 |
$23K |
| 2023 |
494 |
$12K |
| 2024 |
165 |
$6K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
875 |
827 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,306 |
1,230 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,255 |
1,166 |
$17K |
| D1120 |
Prophylaxis - child |
289 |
271 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
178 |
163 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
116 |
99 |
$6K |
| D0274 |
Bitewings - four radiographic images |
122 |
118 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
38 |
$1K |
| D1999 |
|
271 |
208 |
$160.00 |