CHARLES SAMMONS, DDS, PLLC
NPI: 1376712471
· LOUISA, KY 41230
· Health Service Clinic/Center
· NPI assigned 02/22/2008
$114K
Total Medicaid Paid
Provider Details
Related Entities
Other providers sharing the same authorized official: SAMMONS, CHARLES
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,853 |
$39K |
| 2019 |
1,948 |
$38K |
| 2020 |
1,296 |
$22K |
| 2021 |
932 |
$16K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,122 |
1,080 |
$26K |
| D1120 |
Prophylaxis - child |
554 |
539 |
$23K |
| D0272 |
Bitewings - two radiographic images |
800 |
773 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
765 |
736 |
$11K |
| D1110 |
Prophylaxis - adult |
274 |
260 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
258 |
84 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,091 |
1,041 |
$9K |
| D0330 |
Panoramic radiographic image |
225 |
219 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
853 |
815 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
87 |
82 |
$2K |