NPI: 1386712537 · GRAND RAPIDS, MN 55744 · Dentist · NPI assigned 12/04/2006
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 152 | $0.00 |
| 2019 | 12 | $1K |
| 2020 | 75 | $4K |
| 2021 | 455 | $25K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 194 | 194 | $14K |
| D0150 | Comprehensive oral evaluation - new or established patient | 112 | 112 | $5K |
| D0120 | Periodic oral evaluation - established patient | 179 | 179 | $4K |
| D1206 | Topical application of fluoride varnish | 58 | 58 | $2K |
| D1120 | Prophylaxis - child | 50 | 50 | $2K |
| D0210 | Intraoral - complete series of radiographic images | 13 | 13 | $2K |
| D0140 | Limited oral evaluation - problem focused | 20 | 20 | $853.29 |
| D0220 | Intraoral - periapical first radiographic image | 31 | 31 | $567.90 |
| D0274 | Bitewings - four radiographic images | 25 | 25 | $0.00 |
| D9986 | 12 | 12 | $0.00 |