GRAND DENTAL CENTER
NPI: 1457644049
· GRAND RAPIDS, MN 55744
· Dentist
· NPI assigned 05/16/2011
$122K
Total Medicaid Paid
Provider Details
| Authorized Official | JOHNSON, LISA (DENTIST) |
| NPI Enumeration Date | 05/16/2011 |
Related Entities
Other providers sharing the same authorized official: JOHNSON, LISA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
888 |
$2K |
| 2019 |
540 |
$23K |
| 2020 |
384 |
$16K |
| 2021 |
449 |
$24K |
| 2022 |
633 |
$30K |
| 2023 |
394 |
$18K |
| 2024 |
224 |
$9K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,409 |
1,399 |
$52K |
| D1110 |
Prophylaxis - adult |
380 |
376 |
$22K |
| D1206 |
Topical application of fluoride varnish |
934 |
928 |
$21K |
| D1120 |
Prophylaxis - child |
403 |
402 |
$21K |
| D0274 |
Bitewings - four radiographic images |
87 |
86 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
14 |
$2K |
| D9986 |
|
26 |
24 |
$520.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$306.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
166 |
48 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
54 |
$0.00 |