NPI: 1467582023 · SANBORN, IA 51248 · General Practice Dentistry · NPI assigned 03/06/2007
| Authorized Official | BOELTER, TERRY (OWNER) |
| NPI Enumeration Date | 03/06/2007 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 1,077 | $25K |
| 2019 | 1,087 | $28K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 746 | 702 | $15K |
| D1110 | Prophylaxis - adult | 339 | 321 | $12K |
| D1206 | Topical application of fluoride varnish | 640 | 604 | $11K |
| D1120 | Prophylaxis - child | 311 | 289 | $10K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 48 | 27 | $3K |
| D0274 | Bitewings - four radiographic images | 39 | 37 | $1K |
| D0272 | Bitewings - two radiographic images | 41 | 39 | $885.63 |