PONCA TRIBE OF NEBRASKA
NPI: 1285987735
· NORFOLK, NE 68701
· Dental Clinic/Center
· NPI assigned 10/22/2012
$312K
Total Medicaid Paid
Provider Details
| Authorized Official | LEE, DONALD (CHIEF EXECUTIVE OFFICER) |
| NPI Enumeration Date | 10/22/2012 |
Related Entities
Other providers sharing the same authorized official: LEE, DONALD
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
140 |
$52K |
| 2019 |
65 |
$29K |
| 2020 |
45 |
$16K |
| 2021 |
254 |
$57K |
| 2022 |
856 |
$160K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
599 |
536 |
$309K |
| D1999 |
|
374 |
330 |
$3K |
| 90686 |
|
18 |
18 |
$74.97 |
| D1330 |
|
69 |
68 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
26 |
26 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
128 |
121 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
13 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19 |
19 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
32 |
$0.00 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$0.00 |