SAMUEL U. RODGERS HEALTH CENTER, INC.
NPI: 1164614053
· LEXINGTON, MO 64067
· Federally Qualified Health Center (FQHC)
· NPI assigned 08/14/2007
$117K
Total Medicaid Paid
Provider Details
| Authorized Official | FUENTES, HILDA (CHIEF EXECUTIVE OFFICER) |
| NPI Enumeration Date | 08/14/2007 |
Related Entities
Other providers sharing the same authorized official: FUENTES, HILDA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,037 |
$57K |
| 2019 |
1,124 |
$53K |
| 2020 |
192 |
$6K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
332 |
112 |
$37K |
| D1110 |
Prophylaxis - adult |
488 |
400 |
$27K |
| D0272 |
Bitewings - two radiographic images |
562 |
456 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
453 |
365 |
$14K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
106 |
86 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
120 |
93 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
33 |
27 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
175 |
146 |
$3K |
| D0330 |
Panoramic radiographic image |
31 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
53 |
31 |
$711.16 |