Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › MI › HARTFORD › HOLY FAMILY DENTAL CLINICS

HOLY FAMILY DENTAL CLINICS

NPI: 1164170577 · HARTFORD, MI 49057 · Dental Clinic/Center · NPI assigned 03/15/2022

$20K
Total Medicaid Paid
503
Total Claims
496
Beneficiaries
7
Codes Billed
2022-12
First Month
2023-06
Last Month

Provider Details

Authorized OfficialBOUCHARD, DONNIE (PRESIDENT)
NPI Enumeration Date03/15/2022

Related Entities

Other providers sharing the same authorized official: BOUCHARD, DONNIE

ProviderCityStateTotal Paid
HOLY FAMILY HEALTHCARE HARTFORD MI $1.54M
HOLY FAMILY HEALTHCARE KALAMAZOO MI $4K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2022 58 $2K
2023 445 $17K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D1120 Prophylaxis - child 132 132 $6K
D1206 Topical application of fluoride varnish 163 162 $5K
D0150 Comprehensive oral evaluation - new or established patient 88 88 $4K
D2392 Resin-based composite - two surfaces, posterior, primary or permanent 21 15 $3K
D0272 Bitewings - two radiographic images 43 43 $858.00
D0191 40 40 $768.00
D0274 Bitewings - four radiographic images 16 16 $574.00