MARIA A. CRUZ-AGUSTIN D.D.S INC
NPI: 1205053220
· ONTARIO, CA 91761
· General Practice Dentistry
· NPI assigned 04/19/2007
$110K
Total Medicaid Paid
Provider Details
| Authorized Official | AGUSTIN, SAM (CEO) |
| NPI Enumeration Date | 04/19/2007 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,317 |
$19K |
| 2019 |
1,320 |
$27K |
| 2020 |
288 |
$4K |
| 2021 |
431 |
$7K |
| 2022 |
845 |
$22K |
| 2023 |
647 |
$19K |
| 2024 |
456 |
$12K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
712 |
709 |
$39K |
| D1110 |
Prophylaxis - adult |
259 |
259 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,242 |
1,240 |
$15K |
| D0274 |
Bitewings - four radiographic images |
561 |
559 |
$11K |
| D1120 |
Prophylaxis - child |
307 |
304 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,029 |
967 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
52 |
52 |
$3K |
| D0350 |
|
89 |
54 |
$912.00 |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
24 |
$274.00 |
| D1330 |
|
28 |
28 |
$0.00 |