IESOUS DENTAL PLLC
NPI: 1154044162
· HOUSTON, TX 77083
· Clinic/Center
· NPI assigned 09/23/2022
$115K
Total Medicaid Paid
Provider Details
| Authorized Official | GRACIA, VERONICA (OFFICE MANAGER) |
| NPI Enumeration Date | 09/23/2022 |
Related Entities
Other providers sharing the same authorized official: GRACIA, VERONICA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
1,071 |
$47K |
| 2024 |
2,050 |
$68K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
404 |
147 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
229 |
227 |
$14K |
| D1351 |
Sealant - per tooth |
491 |
142 |
$13K |
| D1120 |
Prophylaxis - child |
325 |
321 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
129 |
49 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
229 |
227 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
487 |
481 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
209 |
207 |
$6K |
| D0272 |
Bitewings - two radiographic images |
181 |
179 |
$4K |
| D1110 |
Prophylaxis - adult |
54 |
54 |
$3K |
| D0603 |
|
342 |
335 |
$0.00 |
| D0601 |
|
41 |
38 |
$0.00 |