NPI: 1316620933 · BRIDGETON, MO 63044 · Ambulatory Surgical Clinic/Center · NPI assigned 08/10/2023
Authorized official LARSEN, DEVIN controls 20+ related entities in our dataset. Read more
| Authorized Official | LARSEN, DEVIN (CEO) |
| NPI Enumeration Date | 08/10/2023 |
Other providers sharing the same authorized official: LARSEN, DEVIN
| Year | Claims | Total Paid |
|---|---|---|
| 2024 | 410 | $56K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 60 | 58 | $38K |
| D7140 | Extraction, erupted tooth or exposed root | 48 | 47 | $11K |
| D0150 | Comprehensive oral evaluation - new or established patient | 106 | 106 | $3K |
| D0230 | Intraoral - periapical each additional radiographic image | 84 | 77 | $2K |
| D0272 | Bitewings - two radiographic images | 49 | 49 | $723.15 |
| D0220 | Intraoral - periapical first radiographic image | 63 | 63 | $640.24 |