SHAWN M CUSTER DENTAL PLLC
NPI: 1255083473
· FORT COLLINS, CO 80525
· Dental Clinic/Center
· NPI assigned 01/19/2022
$159K
Total Medicaid Paid
Provider Details
| Authorized Official | CUSTER, SHAWN (OWNER) |
| NPI Enumeration Date | 01/19/2022 |
Related Entities
Other providers sharing the same authorized official: CUSTER, SHAWN
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
1,327 |
$79K |
| 2023 |
1,040 |
$81K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
467 |
218 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
193 |
111 |
$30K |
| D0330 |
Panoramic radiographic image |
477 |
477 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
516 |
516 |
$20K |
| D0274 |
Bitewings - four radiographic images |
428 |
428 |
$13K |
| D1110 |
Prophylaxis - adult |
116 |
116 |
$5K |
| D4342 |
|
29 |
13 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
65 |
65 |
$2K |
| D4346 |
|
20 |
20 |
$884.40 |
| D0220 |
Intraoral - periapical first radiographic image |
19 |
19 |
$238.83 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$205.56 |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$181.32 |