CLINICA DENTAL OF TEXAS PLLC
NPI: 1154063121
· DALLAS, TX 75218
· General Practice Dentistry
· NPI assigned 04/11/2022
$437.42
Total Medicaid Paid
Provider Details
| Authorized Official | KIM, SEHWOON (MANAGING MEMBER) |
| NPI Enumeration Date | 04/11/2022 |
Related Entities
Other providers sharing the same authorized official: KIM, SEHWOON
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
12 |
$0.00 |
| 2024 |
66 |
$437.42 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
28 |
12 |
$299.26 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$138.16 |
| D0601 |
|
38 |
38 |
$0.00 |