NPI: 1396333027 · MT PLEASANT, TX 75455 · Dentist · NPI assigned 01/07/2021
| Year | Claims | Total Paid |
|---|---|---|
| 2023 | 504 | $12K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0145 | Oral evaluation for a patient under three years of age | 46 | 46 | $7K |
| D1351 | Sealant - per tooth | 106 | 16 | $3K |
| D0230 | Intraoral - periapical each additional radiographic image | 152 | 43 | $817.21 |
| D1120 | Prophylaxis - child | 17 | 17 | $588.00 |
| D0220 | Intraoral - periapical first radiographic image | 45 | 45 | $464.72 |
| D1208 | Topical application of fluoride, excluding varnish | 30 | 30 | $441.00 |
| D0120 | Periodic oral evaluation - established patient | 15 | 15 | $432.75 |
| D0602 | 81 | 81 | $0.00 | |
| D0603 | 12 | 12 | $0.00 |