MASON DENTAL PC
NPI: 1306215025
· MANCHESTER, VT 05254
· Customized Equipment (DME)
· NPI assigned 09/23/2015
$613.00
Total Medicaid Paid
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
13 |
$291.00 |
| 2019 |
13 |
$322.00 |
| 2021 |
771 |
$0.00 |
| 2022 |
734 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
719 |
345 |
$613.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
126 |
57 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
18 |
16 |
$0.00 |
| D1110 |
Prophylaxis - adult |
525 |
274 |
$0.00 |
| D1120 |
Prophylaxis - child |
128 |
53 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
15 |
13 |
$0.00 |