NPI: 1154333250 · WINDOM, MN 56101 · Dentist · NPI assigned 08/13/2006
| Authorized Official | ROSSOW, ADALINE (OFFICE MANAGER) |
| NPI Enumeration Date | 08/13/2006 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 51 | $0.00 |
| 2019 | 110 | $3K |
| 2020 | 92 | $2K |
| 2021 | 111 | $3K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 207 | 206 | $4K |
| D1110 | Prophylaxis - adult | 29 | 29 | $1K |
| D1206 | Topical application of fluoride varnish | 56 | 56 | $1K |
| D1120 | Prophylaxis - child | 33 | 33 | $876.15 |
| D0272 | Bitewings - two radiographic images | 27 | 27 | $426.87 |
| D0274 | Bitewings - four radiographic images | 12 | 12 | $376.72 |