Home ›
PR ›
YABUCOA ›
IDENTAL CENTER, PROFESSIONAL DENTISTRY, CSP
IDENTAL CENTER, PROFESSIONAL DENTISTRY, CSP
NPI: 1225161854
· YABUCOA, PR 00767
· General Practice Dentistry
· NPI assigned 03/13/2007
$599K
Total Medicaid Paid
Provider Details
| Authorized Official | GOMEZ, MAYRA (PRESIDENT) |
| NPI Enumeration Date | 03/13/2007 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
3,148 |
$53K |
| 2019 |
5,637 |
$96K |
| 2020 |
2,123 |
$44K |
| 2021 |
2,816 |
$53K |
| 2022 |
5,448 |
$110K |
| 2023 |
5,386 |
$114K |
| 2024 |
6,090 |
$130K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,004 |
4,914 |
$173K |
| D0120 |
Periodic oral evaluation - established patient |
5,725 |
4,661 |
$82K |
| D0272 |
Bitewings - two radiographic images |
4,466 |
3,707 |
$65K |
| D0330 |
Panoramic radiographic image |
2,098 |
1,808 |
$62K |
| D1999 |
|
4,009 |
3,752 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,454 |
2,842 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,684 |
1,471 |
$33K |
| D1120 |
Prophylaxis - child |
1,518 |
1,273 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
618 |
400 |
$24K |
| D1351 |
Sealant - per tooth |
563 |
82 |
$8K |
| D2160 |
|
111 |
85 |
$5K |
| D2140 |
|
132 |
84 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
266 |
221 |
$2K |