MAGICLAND DENTAL LLC
NPI: 1295426963
· HARTFORD, CT 06106
· Orthodontics and Dentofacial Orthopedic Dentist
· NPI assigned 05/15/2023
$171K
Total Medicaid Paid
Provider Details
Related Entities
Other providers sharing the same authorized official: KWON, YOON JOONG
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
425 |
$18K |
| 2024 |
3,131 |
$153K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,006 |
999 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
659 |
657 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
283 |
169 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,002 |
995 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
254 |
253 |
$9K |
| D2160 |
|
38 |
27 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
87 |
87 |
$4K |
| D0272 |
Bitewings - two radiographic images |
102 |
102 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
99 |
98 |
$2K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$564.48 |