NPI: 1316091747 · TIVERTON, RI 02878 · General Practice Dentistry · NPI assigned 01/23/2007
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 99 | $2K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 14 | 14 | $630.00 |
| D1206 | Topical application of fluoride varnish | 14 | 14 | $437.50 |
| D0120 | Periodic oral evaluation - established patient | 14 | 14 | $350.00 |
| D0274 | Bitewings - four radiographic images | 13 | 13 | $156.00 |
| D0220 | Intraoral - periapical first radiographic image | 24 | 23 | $120.00 |
| D0230 | Intraoral - periapical each additional radiographic image | 20 | 20 | $75.00 |