LEAGUE CITY ELITE DENTISTRY
NPI: 1326592601
· LEAGUE CITY, TX 77573
· Dentist
· NPI assigned 08/04/2016
$990.43
Total Medicaid Paid
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
102 |
$990.43 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$346.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
16 |
$264.73 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$191.10 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
16 |
$188.40 |
| D0603 |
|
36 |
35 |
$0.00 |