MY LOCAL COLORADO DENTAL PRACTICE, LLC
NPI: 1417501180
· ARVADA, CO 80003
· General Practice Dentistry
· NPI assigned 07/30/2019
Provider Details
| Authorized Official | KOSTELAC, GREGORY (CREDENTIALING SPECIALIST) |
| Parent Organization | MY LOCAL COLORADO DENTAL PRACTICE, LLC |
| NPI Enumeration Date | 07/30/2019 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
47 |
$2K |
| 2020 |
436 |
$24K |
| 2021 |
172 |
$6K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
277 |
277 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
37 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
99 |
99 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
149 |
149 |
$3K |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$668.50 |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
28 |
$350.20 |