SAGE DENTAL OF JACKSONVILLE MARIETTA PLLC
NPI: 1285413575
· JACKSONVILLE, FL 32220
· Dentist
· NPI assigned 09/26/2023
Provider Details
| Authorized Official | ROARK, CINDY (SVP & CHIEF CLINICAL OFFICER) |
| NPI Enumeration Date | 09/26/2023 |
Related Entities
Other providers sharing the same authorized official: ROARK, CINDY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
159 |
$0.00 |
| 2024 |
4,017 |
$12K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
164 |
131 |
$4K |
| D1120 |
Prophylaxis - child |
292 |
247 |
$3K |
| D0350 |
|
341 |
276 |
$3K |
| D0330 |
Panoramic radiographic image |
55 |
51 |
$570.28 |
| D1206 |
Topical application of fluoride varnish |
550 |
445 |
$384.33 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
57 |
55 |
$344.02 |
| D0274 |
Bitewings - four radiographic images |
541 |
433 |
$292.29 |
| D0220 |
Intraoral - periapical first radiographic image |
653 |
494 |
$154.02 |
| D0230 |
Intraoral - periapical each additional radiographic image |
566 |
455 |
$89.47 |
| D1330 |
|
343 |
281 |
$52.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$0.00 |
| D1351 |
Sealant - per tooth |
209 |
41 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
385 |
318 |
$0.00 |