DIAMOND TRAIL DENTAL PC
NPI: 1164761698
· MONTEZUMA, IA 50171
· Dental Clinic/Center
· NPI assigned 02/04/2013
Provider Details
| Authorized Official | DEBOEF, ERIC (PRESIDENT) |
| NPI Enumeration Date | 02/04/2013 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
26 |
$484.45 |
| 2020 |
209 |
$3K |
| 2021 |
26 |
$612.49 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
54 |
51 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
68 |
67 |
$2K |
| D1206 |
Topical application of fluoride varnish |
56 |
53 |
$915.21 |
| D0272 |
Bitewings - two radiographic images |
14 |
12 |
$212.17 |
| D1999 |
|
69 |
63 |
$0.00 |