GORGEOUS SMILES DENTAL, PC
NPI: 1255027850
· MANCHESTER, CT 06042
· General Practice Dentistry
· NPI assigned 04/17/2023
$116K
Total Medicaid Paid
Provider Details
Related Entities
Other providers sharing the same authorized official: BELISLE, RAYMOND
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
442 |
$9K |
| 2024 |
5,419 |
$107K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,094 |
832 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
548 |
432 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
875 |
194 |
$11K |
| D1110 |
Prophylaxis - adult |
369 |
331 |
$11K |
| D1120 |
Prophylaxis - child |
313 |
257 |
$10K |
| D0330 |
Panoramic radiographic image |
554 |
310 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
413 |
352 |
$9K |
| D1206 |
Topical application of fluoride varnish |
456 |
405 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
839 |
516 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
107 |
98 |
$4K |
| D7230 |
|
43 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
92 |
85 |
$3K |
| D0160 |
|
116 |
69 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30 |
14 |
$470.20 |
| D0270 |
|
12 |
12 |
$81.90 |