FAMILY DENTAL ASSOCIATES
NPI: 1487853644
· RUTLAND, VT 05701
· General Practice Dentistry
· NPI assigned 07/17/2007
$113K
Total Medicaid Paid
Provider Details
| Authorized Official | KOLODZEJ, ROBERT (SENIOR PARTNER) |
| NPI Enumeration Date | 07/17/2007 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
649 |
$21K |
| 2019 |
489 |
$15K |
| 2020 |
608 |
$20K |
| 2021 |
1,986 |
$30K |
| 2022 |
2,450 |
$27K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,383 |
1,481 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,792 |
1,457 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
154 |
$6K |
| D1120 |
Prophylaxis - child |
374 |
157 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
400 |
114 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
12 |
$774.00 |
| D0274 |
Bitewings - four radiographic images |
17 |
15 |
$420.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
12 |
$288.00 |