NPI: 1437549425 · ADRIAN, MI 49221 · General Practice Dentistry · NPI assigned 01/28/2015
| Authorized Official | BERTOLLINI, JASON (PRM) |
| NPI Enumeration Date | 01/28/2015 |
Other providers sharing the same authorized official: BERTOLLINI, JASON
| Provider | City | State | Total Paid |
|---|---|---|---|
| TAWFIQ ALKILANI DDS PLLC | TRAVERSE CITY | MI | $360K |
| PLEASANT SMILES DENTAL CARE, PLLC | MT PLEASANT | MI | $315K |
| GILL DENTAL PC | LANSING | MI | $195K |
| PLEV BC PLC | EAST SYRACUSE | NY | $142K |
| EPP OREGON LLC | TUALATIN | OR | $57K |
| PLEV SAG, PLC | SAGINAW | MI | $27K |
| PLEV, PC | FLINT | MI | $9K |
| PURA VIDA SMILES, PC | JACKSON | MI | $8K |
| VMLP AH PLC | LAKE ORION | MI | $1K |
| SCOTT NIGL DENTAL PC | FORT GRATIOT | MI | $501.00 |
| Year | Claims | Total Paid |
|---|---|---|
| 2020 | 15 | $350.00 |
| 2021 | 1,215 | $22K |
| 2022 | 1,528 | $30K |
| 2023 | 576 | $25K |
| 2024 | 228 | $5K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 453 | 451 | $22K |
| D2740 | Crown - porcelain/ceramic | 19 | 12 | $14K |
| D0274 | Bitewings - four radiographic images | 556 | 556 | $10K |
| D0220 | Intraoral - periapical first radiographic image | 802 | 789 | $8K |
| D0150 | Comprehensive oral evaluation - new or established patient | 227 | 227 | $7K |
| D0330 | Panoramic radiographic image | 152 | 152 | $6K |
| D0120 | Periodic oral evaluation - established patient | 176 | 176 | $5K |
| D0230 | Intraoral - periapical each additional radiographic image | 1,009 | 593 | $4K |
| D0140 | Limited oral evaluation - problem focused | 57 | 55 | $2K |
| D1208 | Topical application of fluoride, excluding varnish | 54 | 54 | $1K |
| D4910 | 13 | 13 | $876.88 | |
| D0270 | 44 | 44 | $463.58 |