KIDS TOWN PEDIATRIC DENTISTRY
NPI: 1356607493
· LAYTON, UT 84040
· Pediatric Dentist
· NPI assigned 04/03/2012
$104K
Total Medicaid Paid
Provider Details
| Authorized Official | PACKHAM, BRETT (OWNER/DENTIST) |
| NPI Enumeration Date | 04/03/2012 |
Related Entities
Other providers sharing the same authorized official: PACKHAM, BRETT
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
74 |
$394.34 |
| 2022 |
376 |
$13K |
| 2023 |
1,838 |
$44K |
| 2024 |
1,837 |
$47K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
736 |
729 |
$27K |
| D1206 |
Topical application of fluoride varnish |
775 |
765 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
695 |
688 |
$17K |
| D0272 |
Bitewings - two radiographic images |
626 |
618 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
607 |
597 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
562 |
553 |
$6K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
37 |
37 |
$1K |
| D0274 |
Bitewings - four radiographic images |
17 |
17 |
$602.79 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$369.07 |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
30 |
$0.00 |