PONTOTOC FAMILY DENTAL PLLC

NPI: 1164941936 · PONTOTOC, MS 38863 · General Practice Dentistry · NPI assigned 09/13/2017

$16K

Total Medicaid Paid

1,817

Total Claims

706

Beneficiaries

Codes Billed

2018-07

First Month

2019-01

Last Month

Provider Details

Authorized Official	TOUPS, PATTY (CEO)
NPI Enumeration Date	09/13/2017

Other providers sharing the same authorized official: TOUPS, PATTY

Provider	City	State	Total Paid
MAGNOLIA ORTHODONTICS	HATTIESBURG	MS	$1.98M
GARNER NICHOLS DENTAL PLLC	HATTIESBURG	MS	$653K
PEARL RIVER DENTAL, PLLC	PEARL	MS	$607K

Year	Claims	Total Paid
2018	1,769	$15K
2019	48	$1K

Code	Description	Claims	Beneficiaries	Total Paid
D0150	Comprehensive oral evaluation - new or established patient	312	134	$4K
D1120	Prophylaxis - child	372	159	$3K
D1206	Topical application of fluoride varnish	356	152	$3K
D0330	Panoramic radiographic image	157	87	$2K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	267	78	$1K
D0274	Bitewings - four radiographic images	121	51	$1K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	135	14	$637.08
D0140	Limited oral evaluation - problem focused	26	17	$601.04
D0210	Intraoral - complete series of radiographic images	71	14	$126.00