ADVANCED DENTAL P.A.
NPI: 1285827014
· PAOLA, KS 66071
· General Practice Dentistry
· NPI assigned 08/24/2007
$777.00
Total Medicaid Paid
Provider Details
| Authorized Official | BOE, IRWIN (DENTIST) |
| NPI Enumeration Date | 08/24/2007 |
Related Entities
Other providers sharing the same authorized official: BOE, IRWIN
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
80 |
$777.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
52 |
29 |
$567.00 |
| D1120 |
Prophylaxis - child |
28 |
12 |
$210.00 |