JACOB, LISA
NPI: 1386688331
· KYLE, TX 78640
· Dentist
· NPI assigned 06/16/2006
$215.81
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
85 |
$215.81 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12 |
12 |
$110.25 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$58.80 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$46.76 |
| D0603 |
|
46 |
46 |
$0.00 |