NPI: 1164684528 · FARMINGTON, CT 06030 · Student in an Organized Health Care Education/Training Program · NPI assigned 06/26/2008
| Year | Claims | Total Paid |
|---|---|---|
| 2022 | 12 | $540.96 |
| 2023 | 43 | $1K |
| 2024 | 505 | $20K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 222 | 205 | $9K |
| D0150 | Comprehensive oral evaluation - new or established patient | 74 | 69 | $4K |
| D1208 | Topical application of fluoride, excluding varnish | 153 | 146 | $4K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 17 | 12 | $2K |
| D0120 | Periodic oral evaluation - established patient | 45 | 40 | $1K |
| D0274 | Bitewings - four radiographic images | 33 | 29 | $1K |
| D0330 | Panoramic radiographic image | 16 | 16 | $1K |