SIMMONS, MARY
NPI: 1366420762
· PORT SANILAC, MI 48469
· General Practice Dentistry
· NPI assigned 01/05/2006
$773.00
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
33 |
$773.00 |
Billing Codes
| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
18 |
18 |
$448.00 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$325.00 |