ALLIANCE DENTAL CARE OF EAST LONGMEADOW LLC

NPI: 1386335933 · EAST LONGMEADOW, MA 01028 · Periodontist · NPI assigned 05/16/2023

$63K

Total Medicaid Paid

1,199

Total Claims

1,145

Beneficiaries

Codes Billed

2023-08

First Month

2024-11

Last Month

Provider Details

Authorized Official	COLE, MICHAEL (VP INSURANCE PLAN MANAGEMENT)
NPI Enumeration Date	05/16/2023

Other providers sharing the same authorized official: COLE, MICHAEL

Provider	City	State	Total Paid
COLUMBIA COUNTY	HUDSON	NY	$7.21M
PDC PEDIATRIC DENTAL CARE PLLC	FAIRFAX	VA	$1.76M
BRIGHT SMILES FAMILY DENTISTRY CENTER PLLC	MARBLE FALLS	TX	$1.10M
ST MARY'S HOME FOR BOYS	BEAVERTON	OR	$914K
GENTLE DENTAL JEFFERSON PLLC	DETROIT	MI	$376K
FAMILY EYE CARE CENTER	LOGAN	UT	$50K
UNIVERSAL MEDICAL SUPPLIERS, INC	SUNBURY	PA	$1K

Year	Claims	Total Paid
2023	230	$7K
2024	969	$56K

Code	Description	Claims	Beneficiaries	Total Paid
D2740	Crown - porcelain/ceramic	24	12	$18K
D1110	Prophylaxis - adult	269	265	$15K
D0150	Comprehensive oral evaluation - new or established patient	313	307	$12K
D0330	Panoramic radiographic image	198	187	$10K
D0274	Bitewings - four radiographic images	232	224	$5K
D0120	Periodic oral evaluation - established patient	74	73	$2K
D0220	Intraoral - periapical first radiographic image	77	65	$691.10
D1208	Topical application of fluoride, excluding varnish	12	12	$329.00