Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
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BOUTIQUE DENTAL

NPI: 1285079962 · GLENDALE, NY 11385 · Dental Clinic/Center · NPI assigned 05/07/2013

$871.82
Total Medicaid Paid
92
Total Claims
92
Beneficiaries
3
Codes Billed
2019-08
First Month
2020-07
Last Month

Provider Details

Authorized OfficialMULLAKANDOVA, YELENA (OWNER/DENTIST)
NPI Enumeration Date05/07/2013

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2019 25 $339.38
2020 67 $532.44

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D0220 Intraoral - periapical first radiographic image 53 53 $522.58
D0150 Comprehensive oral evaluation - new or established patient 12 12 $211.20
D0230 Intraoral - periapical each additional radiographic image 27 27 $138.04