MDC BELLEVUE, L.L.C.
NPI: 1396105474
· GREEN BAY, WI 54311
· General Practice Dentistry
· NPI assigned 03/02/2016
$711.24
Total Medicaid Paid
Provider Details
Related Entities
Other providers sharing the same authorized official: MAUTHE, WILLIAM
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
34 |
$447.10 |
| 2021 |
17 |
$264.14 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
32 |
26 |
$385.28 |
| D1110 |
Prophylaxis - adult |
19 |
15 |
$325.96 |