GALLEGOS, ALMA
NPI: 1376145433
· BERWYN, IL 60402
· General Practice Dentistry
· NPI assigned 11/13/2020
$954.47
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
104 |
$0.00 |
| 2023 |
149 |
$954.47 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
78 |
78 |
$446.00 |
| D1206 |
Topical application of fluoride varnish |
66 |
66 |
$292.65 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$130.40 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$69.22 |
| D0120 |
Periodic oral evaluation - established patient |
59 |
59 |
$16.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$0.00 |