SLPD COTTONWOOD LLC
NPI: 1376044313
· COTTONWOOD HEIGHTS, UT 84121
· Pediatric Dentist
· NPI assigned 02/26/2018
Provider Details
| Authorized Official | GUSTAFSON, DAVID (OWNER/DENTIST) |
| NPI Enumeration Date | 02/26/2018 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
382 |
$8K |
| 2022 |
896 |
$21K |
| 2023 |
1,451 |
$39K |
| 2024 |
744 |
$19K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
779 |
766 |
$22K |
| D1206 |
Topical application of fluoride varnish |
949 |
934 |
$18K |
| D0272 |
Bitewings - two radiographic images |
536 |
524 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
767 |
755 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
270 |
262 |
$12K |
| D0274 |
Bitewings - four radiographic images |
39 |
39 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
109 |
103 |
$928.48 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
24 |
$634.68 |