DENTAL PROFESSIONALS OF INDIANA, P.C.

NPI: 1134868896 · INDIANAPOLIS, IN 46268 · General Practice Dentistry · NPI assigned 06/01/2022

$24K

Total Medicaid Paid

832

Total Claims

705

Beneficiaries

Codes Billed

2022-08

First Month

2024-08

Last Month

Provider Details

Authorized Official	MONTEITH, COURTNEY (CREDENTIALING COORDINATOR)
Parent Organization	DENTAL PROFESSIONALS OF INDIANA, P.C.
NPI Enumeration Date	06/01/2022

Other providers sharing the same authorized official: MONTEITH, COURTNEY

Provider	City	State	Total Paid
LIFETIME DENTAL CARE OF MICHIGAN, P.C.	WARREN	MI	$93K
DENTAL PROFESSIONALS OF OREGON, P.C.	EUGENE	OR	$55K
DENTAL HEALTH PROFESSIONALS OF MICHIGAN, P.C.	GRAND RAPIDS	MI	$1K

Code	Description	Claims	Beneficiaries	Total Paid
D1110	Prophylaxis - adult	282	245	$12K
D0120	Periodic oral evaluation - established patient	214	186	$4K
D0210	Intraoral - complete series of radiographic images	89	72	$3K
D1206	Topical application of fluoride varnish	100	89	$1K
D0274	Bitewings - four radiographic images	36	30	$995.30
D0220	Intraoral - periapical first radiographic image	49	43	$679.70
D0150	Comprehensive oral evaluation - new or established patient	18	16	$557.35
D0140	Limited oral evaluation - problem focused	14	12	$363.36
D0230	Intraoral - periapical each additional radiographic image	30	12	$350.88