NPI: 1316268915 · WEST JORDAN, UT 84084 · Dentist · NPI assigned 06/17/2010
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 803 | $17K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 127 | 126 | $15K |
| D2150 | Silver amalgam - two surfaces, primary or permanent | 21 | 13 | $958.04 |
| D1120 | Prophylaxis - child | 149 | 149 | $715.08 |
| D0272 | Bitewings - two radiographic images | 99 | 98 | $630.89 |
| D0230 | Intraoral - periapical each additional radiographic image | 125 | 117 | $139.00 |
| D0220 | Intraoral - periapical first radiographic image | 139 | 138 | $55.92 |
| D1206 | Topical application of fluoride varnish | 143 | 143 | $17.87 |