DAZZLING SMILE DENTAL GROUP PLLC
NPI: 1225350887
· BAYSIDE, NY 11361
· General Practice Dentistry
· NPI assigned 02/24/2010
$893.46
Total Medicaid Paid
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
24 |
$628.00 |
| 2020 |
26 |
$265.46 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
12 |
12 |
$489.96 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$265.46 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$138.04 |
| D1999 |
|
13 |
12 |
$0.00 |