WILSON DENTAL PLLC
NPI: 1265935902
· BOISE, ID 83704
· Dental Clinic/Center
· NPI assigned 03/08/2018
$616.75
Total Medicaid Paid
Provider Details
| Authorized Official | WILSON, GREGG (DENTIST/CEO) |
| NPI Enumeration Date | 03/08/2018 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
26 |
$616.75 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
12 |
12 |
$616.75 |
| D0120 |
Periodic oral evaluation - established patient |
14 |
14 |
$0.00 |