MAYES, ELISHA
NPI: 1295859742
· LA GRANDE, OR 97850
· Dentist
· NPI assigned 03/19/2007
$194.00
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
41 |
$0.00 |
| 2021 |
128 |
$118.00 |
| 2022 |
51 |
$0.00 |
| 2023 |
102 |
$76.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14 |
14 |
$80.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
75 |
75 |
$76.00 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$38.00 |
| D0220 |
Intraoral - periapical first radiographic image |
40 |
39 |
$0.00 |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$0.00 |
| D1330 |
|
165 |
165 |
$0.00 |