Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › LA › METAIRIE › EXCEPTIONAL DENTAL OF METAIRIE, LLC

EXCEPTIONAL DENTAL OF METAIRIE, LLC

NPI: 1326575945 · METAIRIE, LA 70001 · General Practice Dentistry · NPI assigned 05/13/2017

$9K
Total Medicaid Paid
298
Total Claims
288
Beneficiaries
5
Codes Billed
2019-01
First Month
2022-03
Last Month

Provider Details

Authorized OfficialBOURG, DARRELL (OWNER)
NPI Enumeration Date05/13/2017

Related Entities

Other providers sharing the same authorized official: BOURG, DARRELL

ProviderCityStateTotal Paid
EXCEPTIONAL DENTAL OF KENNER KENNER LA $28K
EXCEPTIONAL DENTAL OF MARRERO MARRERO LA $5K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2019 39 $2K
2020 206 $6K
2021 29 $759.51
2022 24 $564.12

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D1110 Prophylaxis - adult 109 102 $5K
D0120 Periodic oral evaluation - established patient 99 98 $3K
D0150 Comprehensive oral evaluation - new or established patient 25 24 $1K
D0272 Bitewings - two radiographic images 53 52 $707.19
D1208 Topical application of fluoride, excluding varnish 12 12 $237.24