Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › SC › LUGOFF › HARRY J. KOUTROULAKIS D.M.D. FAMILY DENTISTRY, P.A.

HARRY J. KOUTROULAKIS D.M.D. FAMILY DENTISTRY, P.A.

NPI: 1396723326 · LUGOFF, SC 29078 · Dentist · NPI assigned 01/09/2006

$6K
Total Medicaid Paid
270
Total Claims
270
Beneficiaries
3
Codes Billed
2018-02
First Month
2019-10
Last Month

Provider Details

Authorized OfficialKOUTROULAKIS, HARRY (PRESIDENT)
NPI Enumeration Date01/09/2006

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 148 $3K
2019 122 $2K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D0120 Periodic oral evaluation - established patient 124 124 $3K
D1206 Topical application of fluoride varnish 134 134 $2K
D1110 Prophylaxis - adult 12 12 $604.80