ADVANCED DENTAL CARE OF FORTVILLE, LLC
NPI: 1205454014
· FORTVILLE, IN 46040
· Dental Clinic/Center
· NPI assigned 07/08/2020
Provider Details
Related Entities
Other providers sharing the same authorized official: SUMMERLIN, JACK
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
81 |
$4K |
| 2022 |
253 |
$10K |
| 2023 |
734 |
$27K |
| 2024 |
34 |
$2K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
310 |
279 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
285 |
260 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
189 |
157 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
199 |
180 |
$5K |
| D1206 |
Topical application of fluoride varnish |
72 |
66 |
$1K |
| D0274 |
Bitewings - four radiographic images |
31 |
31 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
15 |
$221.32 |