GRAND TETON DENTAL CARE
NPI: 1336457837
· VICTOR, ID 83455
· Dental Clinic/Center
· NPI assigned 09/17/2010
Provider Details
| Authorized Official | CHERRY, ELMER (OWNER) |
| NPI Enumeration Date | 09/17/2010 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
827 |
$16K |
| 2019 |
740 |
$15K |
| 2020 |
732 |
$15K |
| 2021 |
550 |
$13K |
| 2022 |
313 |
$4K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
436 |
435 |
$34K |
| D1120 |
Prophylaxis - child |
390 |
390 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
211 |
211 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
1,061 |
1,059 |
$208.94 |
| D0272 |
Bitewings - two radiographic images |
252 |
251 |
$97.32 |
| D1208 |
Topical application of fluoride, excluding varnish |
399 |
398 |
$13.55 |
| D1206 |
Topical application of fluoride varnish |
390 |
390 |
$0.00 |