BOULEVARD DENTAL CENTER
NPI: 1396015335
· TOA BAJA, PR 00949
· General Practice Dentistry
· NPI assigned 01/09/2012
$193K
Total Medicaid Paid
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
636 |
$9K |
| 2020 |
336 |
$9K |
| 2021 |
1,369 |
$30K |
| 2022 |
1,363 |
$27K |
| 2023 |
1,914 |
$35K |
| 2024 |
4,022 |
$83K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,942 |
1,542 |
$52K |
| D1999 |
|
3,156 |
2,364 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,246 |
998 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
452 |
329 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,105 |
831 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
709 |
534 |
$10K |
| D0272 |
Bitewings - two radiographic images |
467 |
347 |
$7K |
| D1120 |
Prophylaxis - child |
362 |
259 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
91 |
24 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
110 |
86 |
$919.56 |