BALDINO-GOMEZ, MARY ANN
NPI: 1417309568
· LINDENHURST, IL 60046
· Dentist
· NPI assigned 07/12/2016
$210K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
2,925 |
$100K |
| 2024 |
3,029 |
$111K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,024 |
675 |
$65K |
| D1120 |
Prophylaxis - child |
1,398 |
1,398 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,352 |
1,352 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,372 |
1,372 |
$37K |
| D1354 |
|
243 |
151 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$382.20 |
| D0602 |
|
281 |
281 |
$0.00 |
| D0603 |
|
133 |
133 |
$0.00 |
| D0601 |
|
137 |
137 |
$0.00 |