KRISTO LTD
NPI: 1184260358
· SHAWANO, WI 54166
· Orthodontics and Dentofacial Orthopedic Dentist
· NPI assigned 11/22/2019
$449K
Total Medicaid Paid
2,841
Beneficiary Records
Provider Details
| Authorized Official | WEGNER, TAMMY (OPERATIONS MANAGER) |
| Parent Organization | KRISTO LTD |
| NPI Enumeration Date | 11/22/2019 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2024 |
2,985 |
$449K |
Billing Codes
| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,712 |
1,572 |
$272K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
77 |
77 |
$112K |
| D8660 |
|
299 |
298 |
$25K |
| D0330 |
Panoramic radiographic image |
299 |
298 |
$17K |
| D0340 |
|
299 |
298 |
$13K |
| D0350 |
|
299 |
298 |
$10K |