ICON DPMG LLC
NPI: 1134331424
· LEXINGTON, MA 02420
· General Practice Dentistry
· NPI assigned 05/07/2007
$159K
Total Medicaid Paid
Provider Details
| Authorized Official | AHN, HYUNG-JUNG (OWNER/DIRECTOR) |
| NPI Enumeration Date | 05/07/2007 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,145 |
$38K |
| 2019 |
958 |
$32K |
| 2020 |
597 |
$21K |
| 2021 |
881 |
$29K |
| 2022 |
887 |
$29K |
| 2023 |
241 |
$9K |
| 2024 |
30 |
$857.19 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,177 |
2,035 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
2,165 |
2,049 |
$45K |
| D0274 |
Bitewings - four radiographic images |
212 |
202 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
103 |
101 |
$3K |
| D1120 |
Prophylaxis - child |
28 |
27 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
25 |
$987.00 |
| D1999 |
|
26 |
26 |
$0.00 |