WHITE SWAN DENTAL CLNIC
NPI: 1245378389
· WHITE SWAN, WA 98952
· Dental Clinic/Center
· NPI assigned 02/01/2007
$238K
Total Medicaid Paid
Provider Details
| Authorized Official | SAMPSON, JAY (CEO) |
| Parent Organization | WHITE SWAN DENTAL CLINIC |
| NPI Enumeration Date | 02/01/2007 |
Related Entities
Other providers sharing the same authorized official: SAMPSON, JAY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
2,091 |
$197K |
| 2019 |
126 |
$22K |
| 2020 |
90 |
$20K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
816 |
597 |
$226K |
| D1206 |
Topical application of fluoride varnish |
705 |
526 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
193 |
162 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
186 |
171 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
12 |
$853.56 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
24 |
$432.64 |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$335.39 |
| D1351 |
Sealant - per tooth |
114 |
16 |
$153.86 |
| D1330 |
|
127 |
121 |
$0.00 |
| D0191 |
|
102 |
100 |
$0.00 |