SMALL, BETHANY
NPI: 1407928682
· AVON LAKE, OH 44012
· General Practice Dentistry
· NPI assigned 11/14/2006
$960.00
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
13 |
$195.00 |
| 2019 |
48 |
$765.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
36 |
36 |
$525.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$240.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$195.00 |