MOUNTAIN VIEW DENTAL PA
NPI: 1407901697
· WHITEFIELD, NH 03598
· General Practice Dentistry
· NPI assigned 01/25/2007
$127K
Total Medicaid Paid
Provider Details
| Authorized Official | BREWSTER, ROY (PRESIDENT) |
| NPI Enumeration Date | 01/25/2007 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,576 |
$44K |
| 2019 |
1,052 |
$29K |
| 2020 |
749 |
$15K |
| 2021 |
1,046 |
$20K |
| 2022 |
535 |
$9K |
| 2023 |
359 |
$10K |
| 2024 |
31 |
$896.02 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,674 |
1,628 |
$51K |
| D1206 |
Topical application of fluoride varnish |
1,579 |
1,528 |
$28K |
| D1110 |
Prophylaxis - adult |
431 |
427 |
$23K |
| D1120 |
Prophylaxis - child |
539 |
501 |
$19K |
| D0274 |
Bitewings - four radiographic images |
209 |
205 |
$7K |
| D1330 |
|
633 |
629 |
$0.00 |
| D0431 |
|
283 |
282 |
$0.00 |