MODERN DENTAL PROFESSIONALS MINNESOTA PC

NPI: 1316216377 · WELLS, MN 56097 · General Practice Dentistry · NPI assigned 12/21/2011

$45K

Total Medicaid Paid

1,720

Total Claims

1,679

Beneficiaries

Codes Billed

2019-01

First Month

2020-09

Last Month

Provider Details

Authorized Official	MOOS, JEFFREY (CEO)
NPI Enumeration Date	12/21/2011

Other providers sharing the same authorized official: MOOS, JEFFREY

Provider	City	State	Total Paid
MERIT DENTAL MICHIGAN PC	PORTAGE	MI	$161K
MERIT DENTAL OF CONNECTICUT PC	MONDOVI	WI	$16K
MODERN DENTAL PROFESSIONALS, MN PC	EAGAN	MN	$5K

Year	Claims	Total Paid
2019	1,025	$30K
2020	695	$15K

Code	Description	Claims	Beneficiaries	Total Paid
D1110	Prophylaxis - adult	369	365	$15K
D0120	Periodic oral evaluation - established patient	483	479	$12K
D0274	Bitewings - four radiographic images	201	198	$6K
D1206	Topical application of fluoride varnish	259	256	$5K
D1120	Prophylaxis - child	146	146	$4K
D0330	Panoramic radiographic image	32	30	$2K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	27	13	$1K
D0220	Intraoral - periapical first radiographic image	13	12	$133.09
D1999		190	180	$0.00