NM SMILES GO
NPI: 1295080661
· ALBUQUERQUE, NM 87120
· Dental Hygienist
· NPI assigned 07/20/2012
$124K
Total Medicaid Paid
Provider Details
| Authorized Official | JANCSICS, GALE (EXECUTIVE DIRECTOR) |
| NPI Enumeration Date | 07/20/2012 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,644 |
$77K |
| 2019 |
269 |
$11K |
| 2021 |
78 |
$4K |
| 2022 |
574 |
$28K |
| 2023 |
102 |
$5K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
750 |
739 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
682 |
675 |
$23K |
| D1120 |
Prophylaxis - child |
555 |
554 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
475 |
474 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
28 |
$5K |
| D1206 |
Topical application of fluoride varnish |
97 |
97 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
24 |
24 |
$537.84 |