TALL, JACOB
NPI: 1265056121
· IDAHO FALLS, ID 83404
· Dentist
· NPI assigned 06/05/2020
$384.84
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
95 |
$384.84 |
| 2024 |
56 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
25 |
$384.84 |
| D1208 |
Topical application of fluoride, excluding varnish |
88 |
88 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
38 |
38 |
$0.00 |