SPECTRA DENTAL, LLC
NPI: 1437329042
· WATERBURY, CT 06708
· General Practice Dentistry
· NPI assigned 03/11/2008
$123K
Total Medicaid Paid
Provider Details
Related Entities
Other providers sharing the same authorized official: LATHURAS, CHRISTINE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,418 |
$42K |
| 2019 |
1,820 |
$63K |
| 2020 |
534 |
$18K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,137 |
1,100 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
980 |
946 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
792 |
768 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
32 |
$7K |
| D0274 |
Bitewings - four radiographic images |
154 |
151 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
108 |
105 |
$6K |
| D0330 |
Panoramic radiographic image |
65 |
65 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
167 |
158 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
129 |
119 |
$2K |
| 76376 |
|
17 |
15 |
$83.25 |
| D1330 |
|
144 |
140 |
$0.00 |