SABETHA DENTAL LLC
NPI: 1457920548
· SABETHA, KS 66534
· Dental Clinic/Center
· NPI assigned 06/22/2021
$768.26
Total Medicaid Paid
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
25 |
$173.30 |
| 2024 |
31 |
$594.96 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16 |
14 |
$339.64 |
| D1206 |
Topical application of fluoride varnish |
15 |
13 |
$255.32 |
| D1120 |
Prophylaxis - child |
25 |
12 |
$173.30 |