NPI: 1144389065 · SAN FERNANDO, CA 91340 · Dentist · NPI assigned 12/06/2006
| Year | Claims | Total Paid |
|---|---|---|
| 2024 | 155 | $2K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 17 | 17 | $765.00 |
| D1120 | Prophylaxis - child | 13 | 13 | $682.50 |
| D1206 | Topical application of fluoride varnish | 25 | 25 | $387.50 |
| D0274 | Bitewings - four radiographic images | 13 | 13 | $237.60 |
| D0230 | Intraoral - periapical each additional radiographic image | 64 | 16 | $145.80 |
| D1330 | 23 | 23 | $0.00 |