LEE, EOM JI
NPI: 1205219318
· JEFFERSONVILLE, IN 47130
· Dentist
· NPI assigned 07/07/2015
$905.45
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
50 |
$326.81 |
| 2020 |
84 |
$578.64 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
53 |
53 |
$293.42 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$280.80 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$191.85 |
| D0230 |
Intraoral - periapical each additional radiographic image |
57 |
47 |
$139.38 |