PORTSMOUTH PEDIATRIC DENTISTRY
NPI: 1083768188
· PORTSMOUTH, NH 03801
· Pediatric Dentist
· NPI assigned 01/23/2007
$376K
Total Medicaid Paid
Provider Details
| Authorized Official | FILOCOMA, DEBRA (VICE PRESIDENT) |
| NPI Enumeration Date | 01/23/2007 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
2,204 |
$61K |
| 2019 |
3,748 |
$96K |
| 2020 |
2,282 |
$65K |
| 2021 |
1,740 |
$51K |
| 2022 |
1,445 |
$41K |
| 2023 |
1,181 |
$37K |
| 2024 |
663 |
$23K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,918 |
4,751 |
$150K |
| D1120 |
Prophylaxis - child |
2,906 |
2,784 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,235 |
4,072 |
$76K |
| D1110 |
Prophylaxis - adult |
518 |
493 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
326 |
289 |
$12K |
| D0272 |
Bitewings - two radiographic images |
259 |
251 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31 |
31 |
$2K |
| D0274 |
Bitewings - four radiographic images |
43 |
42 |
$1K |
| D0330 |
Panoramic radiographic image |
27 |
17 |
$525.00 |