NPI: 1144970609 · CASA GRANDE, AZ 85122 · General Practice Dentistry · NPI assigned 03/28/2022
Authorized official KOUYOUMDJIAN, RAFFY controls 19+ related entities in our dataset. Read more
| Authorized Official | KOUYOUMDJIAN, RAFFY (OWNER) |
| NPI Enumeration Date | 03/28/2022 |
Other providers sharing the same authorized official: KOUYOUMDJIAN, RAFFY
| Year | Claims | Total Paid |
|---|---|---|
| 2023 | 5,890 | $54K |
| 2024 | 10,329 | $146K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 977 | 327 | $35K |
| D1120 | Prophylaxis - child | 1,760 | 1,739 | $28K |
| D0150 | Comprehensive oral evaluation - new or established patient | 1,360 | 1,343 | $24K |
| D0230 | Intraoral - periapical each additional radiographic image | 2,516 | 1,665 | $16K |
| D0330 | Panoramic radiographic image | 698 | 685 | $16K |
| D1208 | Topical application of fluoride, excluding varnish | 1,845 | 1,821 | $14K |
| D1351 | Sealant - per tooth | 1,400 | 396 | $14K |
| D0220 | Intraoral - periapical first radiographic image | 1,816 | 1,779 | $10K |
| D1110 | Prophylaxis - adult | 363 | 355 | $7K |
| D0120 | Periodic oral evaluation - established patient | 656 | 644 | $7K |
| D0274 | Bitewings - four radiographic images | 530 | 526 | $6K |
| D0272 | Bitewings - two radiographic images | 638 | 624 | $6K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 413 | 391 | $4K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 127 | 60 | $3K |
| D0145 | Oral evaluation for a patient under three years of age | 196 | 196 | $2K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 48 | 29 | $1K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 105 | 31 | $1K |
| D1206 | Topical application of fluoride varnish | 186 | 186 | $1K |
| D0350 | 279 | 160 | $1K | |
| D0210 | Intraoral - complete series of radiographic images | 79 | 77 | $988.50 |
| D0340 | 64 | 64 | $710.47 | |
| D0140 | Limited oral evaluation - problem focused | 39 | 37 | $514.82 |
| D9222 | 29 | 29 | $272.98 | |
| D9223 | Deep sedation/general anesthesia - each subsequent 15 minute increment | 34 | 28 | $272.98 |
| D0160 | 32 | 31 | $149.57 | |
| D9612 | 29 | 29 | $120.52 |