NPI: 1407415870 · JASPER, TX 75951 · General Practice Dentistry · NPI assigned 06/10/2019
| Year | Claims | Total Paid |
|---|---|---|
| 2023 | 466 | $8K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1351 | Sealant - per tooth | 82 | 13 | $2K |
| D0120 | Periodic oral evaluation - established patient | 48 | 48 | $1K |
| D1120 | Prophylaxis - child | 34 | 34 | $1K |
| D0230 | Intraoral - periapical each additional radiographic image | 104 | 53 | $1K |
| D1208 | Topical application of fluoride, excluding varnish | 76 | 71 | $999.60 |
| D0220 | Intraoral - periapical first radiographic image | 55 | 55 | $690.80 |
| D0274 | Bitewings - four radiographic images | 18 | 18 | $622.98 |
| D0602 | 49 | 49 | $0.00 |