NPI: 1376044313 · COTTONWOOD HEIGHTS, UT 84121 · Pediatric Dentist · NPI assigned 02/26/2018
| Authorized Official | GUSTAFSON, DAVID (OWNER/DENTIST) |
| NPI Enumeration Date | 02/26/2018 |
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 382 | $8K |
| 2022 | 896 | $21K |
| 2023 | 1,451 | $39K |
| 2024 | 744 | $19K |
| 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 |