FAMILY AND COSMETIC GENTLE DENTISTRY
NPI: 1164803177
· WAYZATA, MN 55391
· 1223G0001X
$903.98
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
24 |
$622.88 |
| 2019 |
13 |
$281.10 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
|
25 |
25 |
$494.40 |
| D1110 |
|
12 |
12 |
$409.58 |