TOTAL DENTAL FITNESS
NPI: 1265863021
· BLOOMFIELD HILLS, MI 48304
· General Practice Dentistry
· NPI assigned 12/04/2013
$949.00
Total Medicaid Paid
Provider Details
| Authorized Official | MAYLATH, GLEN (PRESIDENT) |
| NPI Enumeration Date | 12/04/2013 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
31 |
$949.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14 |
14 |
$574.00 |
| D1206 |
Topical application of fluoride varnish |
17 |
17 |
$375.00 |