H
NPI: 1356633895
· SOUTH ROYALTON, VT 05068
· General Practice Dentistry
· NPI assigned 05/03/2011
$182K
Total Medicaid Paid
Provider Details
| Authorized Official | HULL, SUSAN (CLINIC COORDINATOR) |
| NPI Enumeration Date | 05/03/2011 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
896 |
$21K |
| 2019 |
825 |
$20K |
| 2020 |
380 |
$10K |
| 2021 |
487 |
$13K |
| 2022 |
267 |
$8K |
| 2023 |
1,771 |
$39K |
| 2024 |
1,659 |
$72K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,578 |
1,500 |
$59K |
| D1206 |
Topical application of fluoride varnish |
2,072 |
1,970 |
$45K |
| D1110 |
Prophylaxis - adult |
495 |
443 |
$28K |
| D1354 |
|
939 |
189 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
140 |
131 |
$13K |
| D0274 |
Bitewings - four radiographic images |
390 |
343 |
$12K |
| D0272 |
Bitewings - two radiographic images |
279 |
245 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
54 |
$1K |
| D1351 |
Sealant - per tooth |
80 |
12 |
$1K |
| D1330 |
|
167 |
110 |
$171.00 |
| D1203 |
|
89 |
49 |
$0.00 |