PHANTASTIC FAMILY DENTAL CENTER
NPI: 1174800486
· PASADENA, TX 77506
· 1223G0001X
$844.90
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
105 |
$844.90 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
|
14 |
14 |
$403.90 |
| D0240 |
|
43 |
15 |
$235.20 |
| D1208 |
|
15 |
15 |
$205.80 |
| D0601 |
|
33 |
31 |
$0.00 |