HOLBROOK DENTAL, LLC
NPI: 1386080042
· HOLBROOK, MA 02343
· Dentist
· NPI assigned 05/21/2013
$747.00
Total Medicaid Paid
Provider Details
| Authorized Official | SALEM, TERESA (OWNER) |
| NPI Enumeration Date | 05/21/2013 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
27 |
$747.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$435.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$312.00 |