NPI: 1144845991 · JACKSON, OH 45640 · General Practice Dentistry · NPI assigned 06/08/2020
| Year | Claims | Total Paid |
|---|---|---|
| 2022 | 14 | $251.02 |
| 2023 | 60 | $1K |
| 2024 | 139 | $7K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 65 | 65 | $4K |
| D0120 | Periodic oral evaluation - established patient | 92 | 92 | $2K |
| D0274 | Bitewings - four radiographic images | 24 | 24 | $958.48 |
| D0150 | Comprehensive oral evaluation - new or established patient | 16 | 16 | $845.92 |
| D1206 | Topical application of fluoride varnish | 16 | 16 | $252.00 |