MINT DENTAL LLC
NPI: 1427641950
· PEARL, MS 39208
· Dental Clinic/Center
· NPI assigned 02/16/2021
$616.72
Total Medicaid Paid
Provider Details
| Authorized Official | LILES, ANTOINETTE (OWNER/OPERATING DENTIST) |
| NPI Enumeration Date | 02/16/2021 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
31 |
$616.72 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16 |
12 |
$346.12 |
| D1206 |
Topical application of fluoride varnish |
15 |
12 |
$270.60 |