EDEN, STACY
NPI: 1114248085
· TIGARD, OR 97224
· Dentist
· NPI assigned 06/15/2010
$103K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
38 |
$6K |
| 2022 |
667 |
$62K |
| 2023 |
370 |
$35K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
699 |
632 |
$80K |
| D9920 |
|
242 |
227 |
$18K |
| D1206 |
Topical application of fluoride varnish |
73 |
73 |
$2K |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$867.68 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$671.00 |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$576.00 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$514.65 |