LTC DENTAL
NPI: 1124619556
· SAINT FRANCIS, WI 53235
· Dental Clinic/Center
· NPI assigned 01/28/2021
$1.18M
Total Medicaid Paid
Provider Details
| Authorized Official | ROBINSON, TARA (OWNER) |
| NPI Enumeration Date | 01/28/2021 |
Related Entities
Other providers sharing the same authorized official: ROBINSON, TARA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
5,113 |
$180K |
| 2022 |
12,985 |
$490K |
| 2023 |
11,171 |
$268K |
| 2024 |
9,575 |
$237K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,034 |
7,731 |
$274K |
| D9410 |
|
6,279 |
6,116 |
$269K |
| D5110 |
|
404 |
375 |
$181K |
| D0191 |
|
13,869 |
13,311 |
$175K |
| D1206 |
Topical application of fluoride varnish |
8,436 |
8,116 |
$131K |
| D5120 |
|
212 |
196 |
$91K |
| D4355 |
|
302 |
298 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
914 |
865 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
205 |
202 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
106 |
105 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
41 |
39 |
$516.57 |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
41 |
$403.94 |