DENTAL GERONA LLC

NPI: 1477299188 · SABANA GRANDE, PR 00637 · Dental Clinic/Center · NPI assigned 05/06/2022

$90K

Total Medicaid Paid

4,175

Total Claims

2,263

Beneficiaries

Codes Billed

2023-03

First Month

2024-12

Last Month

Provider Details

Authorized Official	RODRIGUEZ, MANUEL (DENTIST)
NPI Enumeration Date	05/06/2022

Other providers sharing the same authorized official: RODRIGUEZ, MANUEL

Provider	City	State	Total Paid
CDR MEDICAL CENTER L.L.C.	MOROVIS	PR	$352K
PUZZLE THERAPY SERVICES, INC.	CAPE CORAL	FL	$287K
RODRIGUEZ BAISI PSYCHIATRIC SERVICES LLC	ANCHORAGE	AK	$240K
ROMA OBGYN SERVICES, P.S.C.	MAYAGUEZ	PR	$527.00

Year	Claims	Total Paid
2023	42	$530.26
2024	4,133	$89K

Code	Description	Claims	Beneficiaries	Total Paid
D1110	Prophylaxis - adult	1,371	743	$42K
D0120	Periodic oral evaluation - established patient	1,025	560	$16K
D0150	Comprehensive oral evaluation - new or established patient	489	263	$12K
D0272	Bitewings - two radiographic images	775	414	$12K
D1208	Topical application of fluoride, excluding varnish	385	204	$6K
D0330	Panoramic radiographic image	51	26	$2K
D1120	Prophylaxis - child	28	14	$483.00
D1999		28	27	$349.22
D0220	Intraoral - periapical first radiographic image	23	12	$172.00