GEORGETOWN FAMILY & COSMETIC DENTISTRY PLC
NPI: 1255404992
· JENISON, MI 49428
· General Practice Dentistry
· NPI assigned 11/17/2006
$994.56
Total Medicaid Paid
Provider Details
| Authorized Official | WOLF, TYLER (OWNER DENTIST) |
| NPI Enumeration Date | 11/17/2006 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
12 |
$232.00 |
| 2023 |
26 |
$762.56 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
26 |
26 |
$594.66 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$399.90 |