SULLIVAN FAMILY DENTAL LLC
NPI: 1336547280
· DIGHTON, MA 02715
· Dentist
· NPI assigned 12/09/2014
$214K
Total Medicaid Paid
Provider Details
Related Entities
Other providers sharing the same authorized official: SULLIVAN, ALLYCE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
392 |
$14K |
| 2019 |
773 |
$23K |
| 2020 |
821 |
$23K |
| 2021 |
859 |
$27K |
| 2022 |
1,072 |
$38K |
| 2023 |
1,214 |
$46K |
| 2024 |
1,043 |
$43K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,934 |
1,908 |
$95K |
| D1206 |
Topical application of fluoride varnish |
1,778 |
1,749 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
958 |
940 |
$26K |
| D1110 |
Prophylaxis - adult |
397 |
390 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
312 |
308 |
$9K |
| D0272 |
Bitewings - two radiographic images |
207 |
206 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
89 |
89 |
$5K |
| D0274 |
Bitewings - four radiographic images |
74 |
73 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
14 |
$2K |
| D0603 |
|
394 |
385 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |