RIDEOUT PREVENTATIVE DENTAL
NPI: 1407426307
· DOVER FOXCROFT, ME 04426
· Dental Hygienist
· NPI assigned 07/01/2021
$259K
Total Medicaid Paid
Provider Details
| Authorized Official | RIDEOUT, ASHLEY (OWNER) |
| NPI Enumeration Date | 07/01/2021 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
1,158 |
$37K |
| 2023 |
2,941 |
$118K |
| 2024 |
2,672 |
$104K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
463 |
119 |
$72K |
| D0190 |
|
1,802 |
1,759 |
$37K |
| D1110 |
Prophylaxis - adult |
523 |
508 |
$35K |
| D1120 |
Prophylaxis - child |
654 |
624 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,200 |
1,186 |
$29K |
| D1310 |
|
1,185 |
1,171 |
$25K |
| D1330 |
|
807 |
757 |
$18K |
| D4910 |
|
69 |
69 |
$7K |
| D4355 |
|
28 |
27 |
$3K |
| D0330 |
Panoramic radiographic image |
27 |
25 |
$2K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$624.00 |