STATE 48 DENTAL PLLC
NPI: 1437732054
· GLENDALE, AZ 85305
· Dental Clinic/Center
· NPI assigned 05/02/2021
$454.68
Total Medicaid Paid
Provider Details
| Authorized Official | TRUONG, BRIAN (PRINCIPAL) |
| NPI Enumeration Date | 05/02/2021 |
Related Entities
Other providers sharing the same authorized official: TRUONG, BRIAN
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
61 |
$92.92 |
| 2022 |
12 |
$52.16 |
| 2023 |
34 |
$49.88 |
| 2024 |
60 |
$259.72 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
92 |
81 |
$266.49 |
| D0230 |
Intraoral - periapical each additional radiographic image |
58 |
52 |
$152.77 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
16 |
$35.42 |