POCONO KIDS DENTAL

NPI: 1164590998 · EAST STROUDSBURG, PA 18301 · Dentist · NPI assigned 12/01/2006

$32K

Total Medicaid Paid

1,316

Total Claims

1,280

Beneficiaries

Codes Billed

2020-11

First Month

2024-11

Last Month

Provider Details

Other providers sharing the same authorized official: MARCHOZZI, THOMAS

Provider	City	State	Total Paid
HARTFORD HOSPITAL	HARTFORD	CT	$316.28M
LEHIGH VALLEY HOSPITAL - COORDINATED HEALTH ALLENTOWN	ALLENTOWN	PA	$2.40M
LVHN COORDINATED PROFESSIONAL PRACTICE	ALLENTOWN	PA	$729K
LVHN SCRANTON ORTHOPEDIC SPECIALISTS	DICKSON CITY	PA	$40K
LVHN AMBULATORY SURGERY CENTER OF LOPATCONG, INC.	PHILLIPSBURG	NJ	$27K
LEHIGH VALLEY HOSPITAL - COORDINATED HEALTH BETHLEHEM	BETHLEHEM	PA	$23K
LVHN COORDINATED PROFESSIONAL PRACTICE OF NJ, PC	PHILLIPSBURG	NJ	$23K
LEHIGH VALLEY HOSPITAL MUHLENBERG	BETHLEHEM	PA	$18K
LEHIGH VALLEY HOSPITAL MUHLENBERG	BETHLEHEM	PA	$4K
SCHUYLKILL MEDICAL CENTER - SOUTH JACKSON STREET SPU	POTTSVILLE	PA	$913.99

Code	Description	Claims	Beneficiaries	Total Paid
D1206	Topical application of fluoride varnish	480	476	$8K
D1120	Prophylaxis - child	220	220	$7K
D0120	Periodic oral evaluation - established patient	301	300	$6K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	69	39	$4K
D1110	Prophylaxis - adult	84	83	$3K
D0150	Comprehensive oral evaluation - new or established patient	61	61	$1K
D0272	Bitewings - two radiographic images	60	60	$960.00
D1354		12	12	$750.00
D1330		16	16	$177.28
D1310		13	13	$141.31