NPI: 1255627329 · SHIPROCK, NM 87420 · General Practice Dentistry · NPI assigned 06/27/2011
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 63 | $950.28 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 12 | 12 | $375.43 |
| D0150 | Comprehensive oral evaluation - new or established patient | 13 | 13 | $289.85 |
| D1208 | Topical application of fluoride, excluding varnish | 13 | 12 | $165.00 |
| D0220 | Intraoral - periapical first radiographic image | 25 | 24 | $120.00 |