FOUR MOLAR PSC
NPI: 1164814042
· GUAYNABO, PR 00969
· Oral and Maxillofacial Surgery (Dentist)
· NPI assigned 03/02/2015
$2.99M
Total Medicaid Paid
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
5,081 |
$367K |
| 2019 |
3,983 |
$346K |
| 2020 |
2,440 |
$197K |
| 2021 |
4,298 |
$391K |
| 2022 |
4,096 |
$411K |
| 2023 |
3,909 |
$460K |
| 2024 |
5,746 |
$816K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
4,050 |
1,612 |
$726K |
| D7230 |
|
4,156 |
1,753 |
$674K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,295 |
2,806 |
$624K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,188 |
2,906 |
$420K |
| D0160 |
|
7,546 |
6,499 |
$275K |
| D7220 |
|
929 |
597 |
$138K |
| D0330 |
Panoramic radiographic image |
1,646 |
1,479 |
$52K |
| D1999 |
|
2,146 |
2,057 |
$33K |
| D7250 |
|
406 |
214 |
$27K |
| D9222 |
|
191 |
190 |
$19K |