WESTERN NEW YORK MEDICAL PRACTICE, P.C.
NPI: 1134815301
· PENFIELD, NY 14526
· Dental Clinic/Center
· NPI assigned 04/12/2023
Provider Details
| Authorized Official | HOLDER, NICHOLE (DIRECTOR - PAYER ENROLLMENT) |
| Parent Organization | WESTERN NEW YORK MEDICAL PRACTICE, P.C. |
| NPI Enumeration Date | 04/12/2023 |
Related Entities
Other providers sharing the same authorized official: HOLDER, NICHOLE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
445 |
$18K |
| 2024 |
1,124 |
$63K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
539 |
539 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
320 |
245 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
524 |
524 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
30 |
$3K |
| D0274 |
Bitewings - four radiographic images |
81 |
81 |
$3K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$342.00 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$324.90 |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$292.60 |