NPI: 1184055428 · LORDS VALLEY, PA 18428 · General Practice Dentistry · NPI assigned 12/12/2013
Authorized official JACKSON, FREDERICK controls 14+ related entities in our dataset. Read more
| Authorized Official | JACKSON, FREDERICK (EXECUTIVE DIRECTOR) |
| NPI Enumeration Date | 12/12/2013 |
Other providers sharing the same authorized official: JACKSON, FREDERICK
| Provider | City | State | Total Paid |
|---|---|---|---|
| WAYNE MEMORIAL COMMUNITY HEALTH CENTERS | HONESDALE | PA | $10.50M |
| WAYNE MEMORIAL COMMUNITY HEALTH CENTERS | HONESDALE | PA | $3.50M |
| WAYNE MEMORIAL COMMUNITY HEALTH CENTERS | HAWLEY | PA | $2.32M |
| WAYNE MEMORIAL COMMUNITY HEALTH CENTERS | HONESDALE | PA | $2.06M |
| WAYNE MEMORIAL COMMUNITY HEALTH CENTERS | HONESDALE | PA | $2.00M |
| WAYNE MEMORIAL COMMUNITY HEALTH CENTERS | LAKE ARIEL | PA | $1.95M |
| WAYNE MEMORIAL COMMUNITY HEALTH CENTERS | HONESDALE | PA | $1.58M |
| WAYNE MEMORIAL COMMUNITY HEALTH CENTERS | WAYMART | PA | $1.31M |
| WAYNE MEMORIAL COMMUNITY HEALTH CENTERS | FOREST CITY | PA | $286K |
| WAYNE MEMORIAL COMMUNITY HEALTH CENTERS | TAFTON | PA | $215K |
| WAYNE MEMORIAL COMMUNITY HEALTH CENTERS | HONESDALE | PA | $174K |
| WAYNE MEMORIAL COMMUNITY HEALTH CENTERS | LAKE COMO | PA | $152K |
| WAYNE MEMORIAL COMMUNITY HEALTH CENTERS | HAWLEY | PA | $3K |
| WAYNE MEMORIAL COMMUNITY HEALTH CENTERS | HONESDALE | PA | $789.13 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 498 | $84K |
| 2019 | 562 | $95K |
| 2020 | 19 | $3K |
| 2021 | 3,921 | $259K |
| 2024 | 2,911 | $294K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 3,786 | 3,332 | $735K |
| D0220 | Intraoral - periapical first radiographic image | 285 | 273 | $0.00 |
| D1110 | Prophylaxis - adult | 1,000 | 997 | $0.00 |
| D1120 | Prophylaxis - child | 48 | 48 | $0.00 |
| D0274 | Bitewings - four radiographic images | 380 | 377 | $0.00 |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 84 | 64 | $0.00 |
| D0330 | Panoramic radiographic image | 14 | 12 | $0.00 |
| D1206 | Topical application of fluoride varnish | 192 | 192 | $0.00 |
| D0602 | 24 | 24 | $0.00 | |
| D0150 | Comprehensive oral evaluation - new or established patient | 283 | 280 | $0.00 |
| D0120 | Periodic oral evaluation - established patient | 855 | 852 | $0.00 |
| D0140 | Limited oral evaluation - problem focused | 199 | 192 | $0.00 |
| D1330 | 510 | 509 | $0.00 | |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 145 | 108 | $0.00 |
| D0210 | Intraoral - complete series of radiographic images | 55 | 55 | $0.00 |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 38 | 31 | $0.00 |
| D0603 | 13 | 13 | $0.00 |