SD-DEZAVALA PC
NPI: 1093266306
· SAN ANTONIO, TX 78249
· General Practice Dentistry
· NPI assigned 10/21/2016
Billing Flags
· Automated signals — not evidence of fraud
Entity Proliferation
Authorized official PHAM, LYNHTHY controls 20+ related entities in our dataset. Read more
Provider Details
| Authorized Official | PHAM, LYNHTHY (PRESIDENT) |
| NPI Enumeration Date | 10/21/2016 |
Related Entities
Other providers sharing the same authorized official: PHAM, LYNHTHY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
15 |
$155.04 |
| 2021 |
787 |
$14K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
48 |
47 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
157 |
152 |
$2K |
| D1351 |
Sealant - per tooth |
64 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
161 |
135 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
108 |
107 |
$1K |
| D0274 |
Bitewings - four radiographic images |
49 |
48 |
$1K |
| D1120 |
Prophylaxis - child |
27 |
27 |
$992.25 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
34 |
12 |
$921.48 |
| D0120 |
Periodic oral evaluation - established patient |
33 |
32 |
$914.65 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21 |
21 |
$741.72 |
| D9222 |
|
13 |
12 |
$585.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$169.02 |
| D0601 |
|
30 |
30 |
$0.00 |
| D0603 |
|
29 |
28 |
$0.00 |
| D0602 |
|
16 |
16 |
$0.00 |