LAKESIDE SMILES, PLLC
NPI: 1124417928
· FENNVILLE, MI 49408
· General Practice Dentistry
· NPI assigned 01/16/2015
$104K
Total Medicaid Paid
Provider Details
| Authorized Official | MEYER, MICHAEL (MEMBER) |
| NPI Enumeration Date | 01/16/2015 |
Related Entities
Other providers sharing the same authorized official: MEYER, MICHAEL
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
961 |
$49K |
| 2019 |
657 |
$23K |
| 2020 |
662 |
$22K |
| 2021 |
263 |
$10K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
200 |
114 |
$25K |
| D1120 |
Prophylaxis - child |
583 |
583 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
703 |
703 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
620 |
620 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
114 |
52 |
$10K |
| D1110 |
Prophylaxis - adult |
173 |
173 |
$9K |
| D0272 |
Bitewings - two radiographic images |
81 |
81 |
$2K |
| D0274 |
Bitewings - four radiographic images |
43 |
43 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$1K |