NPI: 1417124058 · O FALLON, IL 62269 · General Practice Dentistry · NPI assigned 05/13/2008
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 993 | $17K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 190 | 173 | $4K |
| D0120 | Periodic oral evaluation - established patient | 131 | 124 | $3K |
| D1206 | Topical application of fluoride varnish | 203 | 186 | $3K |
| D0150 | Comprehensive oral evaluation - new or established patient | 58 | 48 | $2K |
| D0272 | Bitewings - two radiographic images | 124 | 113 | $2K |
| D1351 | Sealant - per tooth | 122 | 29 | $2K |
| D0220 | Intraoral - periapical first radiographic image | 73 | 62 | $670.00 |
| D0230 | Intraoral - periapical each additional radiographic image | 66 | 51 | $575.00 |
| D1110 | Prophylaxis - adult | 13 | 13 | $377.00 |
| D0274 | Bitewings - four radiographic images | 13 | 13 | $273.00 |