PEARL SMILE DENTAL PC
NPI: 1417335985
· UNION CITY, NJ 07087
· General Practice Dentistry
· NPI assigned 05/15/2015
$900.25
Total Medicaid Paid
Provider Details
| Authorized Official | KHALID, RASHID (OWNER) |
| NPI Enumeration Date | 05/15/2015 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
196 |
$319.25 |
| 2019 |
290 |
$551.00 |
| 2020 |
25 |
$30.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
138 |
138 |
$540.50 |
| D0120 |
Periodic oral evaluation - established patient |
79 |
79 |
$103.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
13 |
$96.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
73 |
72 |
$81.50 |
| D0220 |
Intraoral - periapical first radiographic image |
129 |
127 |
$78.75 |
| D0274 |
Bitewings - four radiographic images |
56 |
55 |
$0.00 |