SMILE LOFT GAITHERSBURG LLC
NPI: 1154917904
· GAITHERSBURG, MD 20877
· General Practice Dentistry
· NPI assigned 12/16/2020
Provider Details
| Authorized Official | RAI, CHRISTINE (HR DIRECTOR) |
| NPI Enumeration Date | 12/16/2020 |
Related Entities
Other providers sharing the same authorized official: RAI, CHRISTINE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
112 |
$3K |
| 2024 |
116 |
$5K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$2K |
| D1110 |
Prophylaxis - adult |
33 |
27 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
25 |
$1K |
| D0274 |
Bitewings - four radiographic images |
43 |
39 |
$938.73 |
| D0220 |
Intraoral - periapical first radiographic image |
59 |
55 |
$669.80 |
| D0330 |
Panoramic radiographic image |
18 |
12 |
$551.40 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$477.15 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$315.48 |