DENTAL GALLERY PSC
NPI: 1295139707
· SAN JUAN, PR 00927
· Dental Clinic/Center
· NPI assigned 10/13/2014
$113K
Total Medicaid Paid
Provider Details
| Authorized Official | RIVERA, ELISA (DENTIST) |
| NPI Enumeration Date | 10/13/2014 |
Related Entities
Other providers sharing the same authorized official: RIVERA, ELISA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
726 |
$15K |
| 2019 |
295 |
$6K |
| 2020 |
753 |
$20K |
| 2021 |
1,357 |
$31K |
| 2022 |
1,065 |
$24K |
| 2023 |
464 |
$9K |
| 2024 |
404 |
$8K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,428 |
1,289 |
$38K |
| D1999 |
|
1,840 |
1,515 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
530 |
519 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
871 |
826 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
257 |
247 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
111 |
110 |
$2K |
| D1120 |
Prophylaxis - child |
15 |
15 |
$315.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$155.25 |