CRISDENTAL EAGLE POINT LLC

NPI: 1326454679 · EAGLE POINT, OR 97524 · General Practice Dentistry · NPI assigned 07/08/2014

$1K

Total Medicaid Paid

12,641

Total Claims

4,469

Beneficiaries

Codes Billed

2018-01

First Month

2018-11

Last Month

Provider Details

Other providers sharing the same authorized official: BRATLAND, MICHAEL

Provider	City	State	Total Paid
CRISDENTAL GRANTS PASS LLC	GRANTS PASS	OR	$6K
CRISDENTAL SALEM L.L.C.	SALEM	OR	$1K
CRIS DENTAL GROUP	EUGENE	OR	$137.00
CRIS DENTAL GROUP	SPRINGFIELD	OR	$111.00
CRISDENTAL LINCOLN CITY, LLC	LINCOLN CITY	OR	$46.00
AMERICAN DENTAL L.L.C	ROSEBURG	OR	$0.00
CRISDENTAL CENTRAL POINT	CENTRAL POINT	OR	$0.00

Year	Claims	Total Paid
2018	12,641	$1K

Code	Description	Claims	Beneficiaries	Total Paid
D1120	Prophylaxis - child	235	175	$238.00
D1208	Topical application of fluoride, excluding varnish	511	381	$192.00
D1354		7,229	640	$140.00
D0120	Periodic oral evaluation - established patient	223	171	$130.00
D1110	Prophylaxis - adult	207	156	$84.00
D0603		1,448	1,024	$55.00
D0274	Bitewings - four radiographic images	115	86	$46.00
D0330	Panoramic radiographic image	129	97	$42.00
D0150	Comprehensive oral evaluation - new or established patient	66	47	$35.00
D0140	Limited oral evaluation - problem focused	275	201	$32.00
D0220	Intraoral - periapical first radiographic image	221	165	$30.00
D1330		1,818	1,223	$0.00
D0601		23	12	$0.00
D1351	Sealant - per tooth	20	12	$0.00
D0272	Bitewings - two radiographic images	63	40	$0.00
D0270		58	39	$0.00