DC DENTAL, LLC
NPI: 1447487632
· GOODYEAR, AZ 85338
· General Practice Dentistry
· NPI assigned 06/16/2009
$990.22
Total Medicaid Paid
Provider Details
| Authorized Official | NAVARRA, TONY (VICE PRESIDENT) |
| NPI Enumeration Date | 06/16/2009 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
54 |
$990.22 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14 |
14 |
$462.70 |
| D0120 |
Periodic oral evaluation - established patient |
14 |
14 |
$309.68 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$217.84 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$0.00 |