MPDA BROKEN BOW LLC
NPI: 1376294298
· BROKEN BOW, NE 68822
· General Practice Dentistry
· NPI assigned 01/12/2022
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
189 |
$5K |
| 2023 |
290 |
$8K |
| 2024 |
279 |
$8K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
381 |
376 |
$9K |
| D1110 |
Prophylaxis - adult |
178 |
171 |
$6K |
| D1206 |
Topical application of fluoride varnish |
110 |
106 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
42 |
38 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$308.28 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$288.47 |