GREAT LAKES FAMILY DENTAL GROUP BLISSFIELD PC
NPI: 1386835999
· BLISSFIELD, MI 49228
· General Practice Dentistry
· NPI assigned 08/08/2007
$142K
Total Medicaid Paid
Provider Details
| Authorized Official | HART, PATRICIA (GENERAL MANAGER) |
| NPI Enumeration Date | 08/08/2007 |
Related Entities
Other providers sharing the same authorized official: HART, PATRICIA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
895 |
$30K |
| 2019 |
1,085 |
$34K |
| 2020 |
575 |
$16K |
| 2021 |
953 |
$31K |
| 2022 |
918 |
$30K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,169 |
1,169 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,443 |
1,443 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,320 |
1,320 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
106 |
64 |
$12K |
| D1110 |
Prophylaxis - adult |
162 |
162 |
$8K |
| D0272 |
Bitewings - two radiographic images |
153 |
153 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
34 |
33 |
$610.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$396.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
26 |
$275.00 |