NPI: 1336661693 · RAYTOWN, MO 64138 · General Practice Dentistry · NPI assigned 07/07/2017
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 61 | $1K |
| 2019 | 127 | $2K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 26 | 26 | $572.00 |
| D0220 | Intraoral - periapical first radiographic image | 52 | 50 | $520.00 |
| D0150 | Comprehensive oral evaluation - new or established patient | 12 | 12 | $473.00 |
| D0230 | Intraoral - periapical each additional radiographic image | 56 | 46 | $450.00 |
| D0274 | Bitewings - four radiographic images | 15 | 15 | $330.00 |
| D0120 | Periodic oral evaluation - established patient | 13 | 13 | $325.00 |
| D1206 | Topical application of fluoride varnish | 14 | 14 | $196.00 |