LAKESHORE COMMUNITY HEALTH CARE, INC
NPI: 1184358004
· WEST BEND, WI 53095
· Federally Qualified Health Center (FQHC)
· NPI assigned 07/15/2022
Provider Details
| Authorized Official | JENSEMA, CALEB (CFO) |
| NPI Enumeration Date | 07/15/2022 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
82 |
$2K |
| 2024 |
150 |
$5K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
22 |
12 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
93 |
83 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
49 |
41 |
$1K |
| D1206 |
Topical application of fluoride varnish |
53 |
46 |
$685.90 |
| D1110 |
Prophylaxis - adult |
15 |
13 |
$301.52 |