PRISTINE SMILE DENTAL PLLC
NPI: 1316692106
· MANCHESTER, CT 06040
· General Practice Dentistry
· NPI assigned 02/20/2022
Provider Details
| Authorized Official | HERNANDEZ, JASON (DENTIST OWNER) |
| NPI Enumeration Date | 02/20/2022 |
Related Entities
Other providers sharing the same authorized official: HERNANDEZ, JASON
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
135 |
$4K |
| 2024 |
319 |
$12K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
188 |
177 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
97 |
87 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
42 |
$2K |
| D1206 |
Topical application of fluoride varnish |
49 |
48 |
$1K |
| D0274 |
Bitewings - four radiographic images |
25 |
24 |
$876.96 |
| D1208 |
Topical application of fluoride, excluding varnish |
37 |
29 |
$738.92 |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$166.40 |