ELICA HEALTH CENTERS
NPI: 1154947711
· SACRAMENTO, CA 95823
· Case Manager/Care Coordinator
· NPI assigned 06/19/2020
$650.36
Total Medicaid Paid
Provider Details
| Authorized Official | BAK, TATYANA (CEO) |
| Parent Organization | ELICA HEALTH CENTERS |
| NPI Enumeration Date | 06/19/2020 |
Related Entities
Other providers sharing the same authorized official: BAK, TATYANA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
26 |
$0.00 |
| 2023 |
1,099 |
$102.00 |
| 2024 |
955 |
$548.36 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
138 |
136 |
$330.03 |
| D1120 |
Prophylaxis - child |
14 |
14 |
$320.33 |
| D1330 |
|
262 |
258 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
155 |
152 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
217 |
212 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
18 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$0.00 |
| D4341 |
|
309 |
111 |
$0.00 |
| D4910 |
|
90 |
90 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
280 |
251 |
$0.00 |
| D9430 |
|
203 |
189 |
$0.00 |
| D0330 |
Panoramic radiographic image |
94 |
90 |
$0.00 |
| D0350 |
|
146 |
123 |
$0.00 |
| D0270 |
|
83 |
76 |
$0.00 |