WESTERN DENTAL SERVICES, INC.
NPI: 1093419681
· ARROYO GRANDE, CA 93420
· Dentist
· NPI assigned 03/28/2023
$194K
Total Medicaid Paid
Provider Details
| Authorized Official | DEMBERECKY, WILLIAM (EVP & CHIEF STRATEGY AND GROWTH) |
| NPI Enumeration Date | 03/28/2023 |
Related Entities
Other providers sharing the same authorized official: DEMBERECKY, WILLIAM
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
1,665 |
$92K |
| 2024 |
1,699 |
$102K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
903 |
903 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
759 |
758 |
$36K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
224 |
89 |
$27K |
| D4341 |
|
274 |
76 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
276 |
154 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
197 |
121 |
$13K |
| D1110 |
Prophylaxis - adult |
148 |
148 |
$13K |
| D1206 |
Topical application of fluoride varnish |
322 |
318 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
131 |
125 |
$3K |
| D1120 |
Prophylaxis - child |
44 |
43 |
$2K |
| D0350 |
|
69 |
33 |
$652.80 |
| D0274 |
Bitewings - four radiographic images |
17 |
17 |
$345.60 |