LET'S SMILE, INC.
NPI: 1295169662
· OWATONNA, MN 55060
· Dental Hygienist
· NPI assigned 08/21/2013
$259K
Total Medicaid Paid
Provider Details
| Authorized Official | JORGENSEN, HOLLY (EXECUTIVE DIRECTOR) |
| NPI Enumeration Date | 08/21/2013 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
905 |
$2K |
| 2019 |
1,092 |
$22K |
| 2020 |
346 |
$7K |
| 2021 |
1,667 |
$36K |
| 2022 |
1,772 |
$40K |
| 2023 |
2,477 |
$58K |
| 2024 |
4,657 |
$94K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,192 |
2,179 |
$89K |
| D1206 |
Topical application of fluoride varnish |
2,776 |
2,759 |
$75K |
| D1330 |
|
2,006 |
1,989 |
$49K |
| D1110 |
Prophylaxis - adult |
350 |
348 |
$21K |
| D9410 |
|
1,865 |
1,856 |
$11K |
| D1310 |
|
683 |
672 |
$5K |
| D1351 |
Sealant - per tooth |
88 |
25 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
49 |
48 |
$2K |
| D0350 |
|
187 |
184 |
$2K |
| D0274 |
Bitewings - four radiographic images |
16 |
16 |
$849.25 |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
12 |
$480.72 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$291.30 |
| D0191 |
|
2,436 |
2,414 |
$0.00 |
| D0190 |
|
217 |
217 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$0.00 |