NPI: 1194053397 · ACWORTH, GA 30101 · Dentist · NPI assigned 11/27/2009
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 3,133 | $74K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 659 | 656 | $24K |
| D0120 | Periodic oral evaluation - established patient | 732 | 729 | $20K |
| D1206 | Topical application of fluoride varnish | 655 | 653 | $15K |
| D1351 | Sealant - per tooth | 445 | 225 | $14K |
| D0602 | 212 | 211 | $0.00 | |
| D0601 | 304 | 303 | $0.00 | |
| D0603 | 126 | 126 | $0.00 |