FAMILY DENTAL HEALTH SERVICES, INC
NPI: 1205040235
· MT PLEASANT, IA 52641
· General Practice Dentistry
· NPI assigned 05/09/2007
$152K
Total Medicaid Paid
Provider Details
| Authorized Official | WETTACH, MARY (PRESIDENT) |
| NPI Enumeration Date | 05/09/2007 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,238 |
$26K |
| 2019 |
1,227 |
$27K |
| 2020 |
994 |
$22K |
| 2021 |
879 |
$20K |
| 2022 |
914 |
$20K |
| 2023 |
967 |
$23K |
| 2024 |
489 |
$13K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,085 |
2,012 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
3,365 |
3,235 |
$55K |
| D1120 |
Prophylaxis - child |
663 |
631 |
$16K |
| D0274 |
Bitewings - four radiographic images |
215 |
210 |
$5K |
| D1206 |
Topical application of fluoride varnish |
239 |
235 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
98 |
97 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
38 |
$335.72 |