CHILDREN'S DENTAL CLINIC OF GREEN BAY, LLC
NPI: 1306543095
· DE PERE, WI 54115
· Pediatric Dentist
· NPI assigned 02/13/2023
$390.00
Total Medicaid Paid
Provider Details
| Authorized Official | HAWS, KAITLIN (INSURANCE COORDINATOR) |
| NPI Enumeration Date | 02/13/2023 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
242 |
$0.00 |
| 2024 |
42 |
$390.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$390.00 |
| D1120 |
Prophylaxis - child |
61 |
42 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
17 |
13 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
112 |
80 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
66 |
47 |
$0.00 |