NPI: 1134320120 · ADRIAN, MI 49221 · Dentist · NPI assigned 05/29/2007
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 155 | $4K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 43 | 43 | $2K |
| D0120 | Periodic oral evaluation - established patient | 44 | 44 | $1K |
| D1206 | Topical application of fluoride varnish | 36 | 36 | $800.00 |
| D0220 | Intraoral - periapical first radiographic image | 16 | 16 | $238.00 |
| D0230 | Intraoral - periapical each additional radiographic image | 16 | 16 | $126.00 |