MODERN DENTAL PROFESSIONALS UT, PC
NPI: 1265889166
· SOUTH OGDEN, UT 84403
· Dentist
· NPI assigned 05/20/2016
Provider Details
| Authorized Official | MARTINEZ, LILIANA (CREDENTIALING DIRECTOR) |
| Parent Organization | MODERN DENTAL PROFESSIONALS UT, PC |
| NPI Enumeration Date | 05/20/2016 |
Related Entities
Other providers sharing the same authorized official: MARTINEZ, LILIANA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
14 |
$1K |
| 2019 |
212 |
$13K |
| 2020 |
58 |
$5K |
| 2024 |
116 |
$3K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
155 |
155 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
12 |
$4K |
| D0274 |
Bitewings - four radiographic images |
63 |
63 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
57 |
52 |
$496.71 |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$343.86 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$341.93 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
26 |
$273.45 |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$264.35 |