BELLAIREFAMILY & COSMETIC DENTISTRY, PC
NPI: 1356554596
· BELLAIRE, MI 49615
· General Practice Dentistry
· NPI assigned 05/07/2007
$120K
Total Medicaid Paid
Provider Details
| Authorized Official | RATHKE, LISA (OFFICE MANAGER) |
| NPI Enumeration Date | 05/07/2007 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
502 |
$17K |
| 2019 |
558 |
$17K |
| 2020 |
471 |
$12K |
| 2021 |
561 |
$14K |
| 2022 |
585 |
$16K |
| 2023 |
942 |
$26K |
| 2024 |
636 |
$17K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,611 |
1,611 |
$39K |
| D1120 |
Prophylaxis - child |
930 |
930 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,237 |
1,237 |
$26K |
| D1110 |
Prophylaxis - adult |
354 |
354 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
14 |
$2K |
| D0274 |
Bitewings - four radiographic images |
62 |
62 |
$2K |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$991.50 |