BOUTIQUE DENTAL
NPI: 1285079962
· GLENDALE, NY 11385
· Dental Clinic/Center
· NPI assigned 05/07/2013
$871.82
Total Medicaid Paid
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
25 |
$339.38 |
| 2020 |
67 |
$532.44 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total 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 |