ROUSTUM, HALA
NPI: 1356436091
· AMHERST, NY 14228
· General Practice Dentistry
· NPI assigned 10/04/2006
$109K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
64 |
$3K |
| 2019 |
166 |
$6K |
| 2020 |
307 |
$11K |
| 2021 |
553 |
$22K |
| 2022 |
725 |
$27K |
| 2023 |
716 |
$26K |
| 2024 |
412 |
$15K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,240 |
1,239 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
1,163 |
1,161 |
$31K |
| D0274 |
Bitewings - four radiographic images |
253 |
253 |
$7K |
| D0330 |
Panoramic radiographic image |
108 |
108 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
71 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
74 |
74 |
$1K |
| D1999 |
|
34 |
33 |
$0.00 |