NPI: 1104082437 · CLARKSTON, MI 48346 · Dentist · NPI assigned 08/06/2008
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 676 | $28K |
| 2019 | 24 | $51.32 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 212 | 212 | $8K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 65 | 37 | $7K |
| D0120 | Periodic oral evaluation - established patient | 183 | 183 | $6K |
| D1206 | Topical application of fluoride varnish | 155 | 155 | $4K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 15 | 12 | $2K |
| D0272 | Bitewings - two radiographic images | 45 | 45 | $1K |
| D0220 | Intraoral - periapical first radiographic image | 25 | 25 | $455.80 |