ST. CROIX DENTAL HEALTH, LLC
NPI: 1164996997
· WEBSTER, WI 54893
· General Practice Dentistry
· NPI assigned 01/15/2019
$0.00
Total Medicaid Paid
Provider Details
| Authorized Official | MORTEL, TANYA (CREDENTIALING COORDINATOR) |
| NPI Enumeration Date | 01/15/2019 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
79 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
25 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
35 |
18 |
$0.00 |
| D1110 |
Prophylaxis - adult |
16 |
15 |
$0.00 |