AGAPE DENTISTRY, PC
NPI: 1215106430
· SIOUX CENTER, IA 51250
· General Practice Dentistry
· NPI assigned 02/21/2008
$106K
Total Medicaid Paid
Provider Details
| Authorized Official | KOELE, DIANE (OFFICE ADMINISTRATOR) |
| NPI Enumeration Date | 02/21/2008 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
682 |
$19K |
| 2019 |
996 |
$25K |
| 2020 |
881 |
$23K |
| 2021 |
1,119 |
$31K |
| 2022 |
221 |
$7K |
| 2024 |
14 |
$518.05 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,549 |
1,523 |
$36K |
| D1110 |
Prophylaxis - adult |
750 |
735 |
$30K |
| D1120 |
Prophylaxis - child |
434 |
426 |
$15K |
| D1206 |
Topical application of fluoride varnish |
745 |
733 |
$12K |
| D0274 |
Bitewings - four radiographic images |
285 |
283 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
26 |
$3K |
| D0272 |
Bitewings - two radiographic images |
110 |
107 |
$2K |