NPI: 1124869342 · CLEVELAND, TX 77327 · Dentist · NPI assigned 06/03/2024
| Authorized Official | ORTEGA, LUIS (OWNER) |
| NPI Enumeration Date | 06/03/2024 |
| Year | Claims | Total Paid |
|---|---|---|
| 2024 | 316 | $6K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 51 | 51 | $1K |
| D1120 | Prophylaxis - child | 30 | 30 | $1K |
| D1208 | Topical application of fluoride, excluding varnish | 53 | 53 | $764.40 |
| D1110 | Prophylaxis - adult | 13 | 13 | $658.56 |
| D0220 | Intraoral - periapical first radiographic image | 44 | 44 | $540.08 |
| D0230 | Intraoral - periapical each additional radiographic image | 43 | 43 | $483.42 |
| D0272 | Bitewings - two radiographic images | 15 | 15 | $350.70 |
| D0274 | Bitewings - four radiographic images | 12 | 12 | $346.10 |
| D0602 | 28 | 28 | $0.00 | |
| D0603 | 14 | 14 | $0.00 | |
| D0601 | 13 | 13 | $0.00 |