LUGOFF FAMILY DENTISTRY, LLC
NPI: 1295321198
· LUGOFF, SC 29078
· Dental Clinic/Center
· NPI assigned 12/15/2020
$467.00
Total Medicaid Paid
Provider Details
| Authorized Official | RICKARD, JOHN (COMPTROLLER) |
| NPI Enumeration Date | 12/15/2020 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
24 |
$467.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$272.60 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$194.40 |