NPI: 1245772995 · KATY, TX 77450 · Dental Clinic/Center · NPI assigned 11/11/2016
| Authorized Official | KOFOWOROLA-KUTI, ANTHONY (CLINICAL DIRECTOR) |
| NPI Enumeration Date | 11/11/2016 |
| Year | Claims | Total Paid |
|---|---|---|
| 2020 | 32 | $205.80 |
| 2021 | 275 | $1K |
| 2022 | 475 | $5K |
| 2023 | 195 | $2K |
| 2024 | 73 | $696.97 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 169 | 161 | $4K |
| D1208 | Topical application of fluoride, excluding varnish | 283 | 264 | $4K |
| D1120 | Prophylaxis - child | 24 | 24 | $878.33 |
| D1110 | Prophylaxis - adult | 14 | 14 | $689.31 |
| D0274 | Bitewings - four radiographic images | 12 | 12 | $316.28 |
| D1330 | 283 | 265 | $37.25 | |
| D0602 | 136 | 130 | $9.06 | |
| D0601 | 129 | 116 | $0.00 |