JEWELL LAKE DENTAL LLC
NPI: 1114238151
· BARTON CITY, MI 48705
· Dentist
· NPI assigned 06/24/2010
Provider Details
Related Entities
Other providers sharing the same authorized official: RODRIGUEZ, STEVEN
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
38 |
$1K |
| 2021 |
158 |
$5K |
| 2022 |
92 |
$3K |
| 2023 |
198 |
$6K |
| 2024 |
116 |
$3K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
86 |
86 |
$4K |
| D1206 |
Topical application of fluoride varnish |
148 |
148 |
$4K |
| D1120 |
Prophylaxis - child |
89 |
89 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
77 |
77 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
121 |
113 |
$2K |
| D0274 |
Bitewings - four radiographic images |
17 |
17 |
$586.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
52 |
45 |
$421.93 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$396.00 |