IOWA DENTAL HEALTH PROFESSIONALS, P.C.

NPI: 1346630654 · SIOUX CITY, IA 51106 · General Practice Dentistry · NPI assigned 01/26/2015

$53K

Total Medicaid Paid

1,334

Total Claims

1,175

Beneficiaries

Codes Billed

2018-01

First Month

2019-04

Last Month

Provider Details

Authorized Official	WOODS, CARMEN (CREDENTIALING)
Parent Organization	IOWA DENTAL HEALTH PROFESSIONALS, P.C.
NPI Enumeration Date	01/26/2015

Other providers sharing the same authorized official: WOODS, CARMEN

Provider	City	State	Total Paid
DENTAL PROFESSIONALS OF IN, P.C.	GREENCASTLE	IN	$132K
CNWOODS & ASSOCIATES LLC	BESSEMER	AL	$23K
DENTAL PROFESSIONALS OF VIRGINIA, P.C.	VIRGINIA BEACH	VA	$0.00

Year	Claims	Total Paid
2018	999	$44K
2019	335	$9K

Code	Description	Claims	Beneficiaries	Total Paid
D2740	Crown - porcelain/ceramic	53	27	$12K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	157	98	$11K
D0210	Intraoral - complete series of radiographic images	160	154	$7K
D1110	Prophylaxis - adult	176	171	$6K
D1206	Topical application of fluoride varnish	368	354	$5K
D2950		69	39	$4K
D0150	Comprehensive oral evaluation - new or established patient	155	151	$3K
D0120	Periodic oral evaluation - established patient	147	142	$3K
D2391	Resin-based composite - one surface, posterior, primary or permanent	23	13	$953.35
D0274	Bitewings - four radiographic images	26	26	$739.69