ADDISON VILLAGE DENTAL, INC
NPI: 1265863518
· GLASTONBURY, CT 06033
· General Practice Dentistry
· NPI assigned 12/11/2013
$138K
Total Medicaid Paid
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
727 |
$19K |
| 2019 |
1,452 |
$39K |
| 2020 |
678 |
$16K |
| 2021 |
747 |
$21K |
| 2022 |
970 |
$28K |
| 2023 |
247 |
$8K |
| 2024 |
163 |
$6K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
850 |
820 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,729 |
1,607 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,228 |
1,156 |
$30K |
| D1110 |
Prophylaxis - adult |
621 |
541 |
$17K |
| D0274 |
Bitewings - four radiographic images |
308 |
296 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
95 |
75 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
52 |
43 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
87 |
75 |
$950.76 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$334.52 |