FAMILY DENTAL HEALTH OF REIDVILLE CIRCLE, LLC
NPI: 1497110035
· SPARTANBURG, SC 29301
· Dentist
· NPI assigned 12/28/2015
$112K
Total Medicaid Paid
Provider Details
| Authorized Official | SAFRIT, BOBBY (OWNER) |
| Parent Organization | FDH HOLDINGS |
| NPI Enumeration Date | 12/28/2015 |
Related Entities
Other providers sharing the same authorized official: SAFRIT, BOBBY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
104 |
$4K |
| 2019 |
702 |
$27K |
| 2020 |
1,473 |
$48K |
| 2021 |
831 |
$26K |
| 2022 |
289 |
$7K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
778 |
778 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
515 |
515 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
516 |
516 |
$11K |
| D0274 |
Bitewings - four radiographic images |
338 |
338 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
101 |
54 |
$9K |
| D1120 |
Prophylaxis - child |
153 |
153 |
$5K |
| D1206 |
Topical application of fluoride varnish |
321 |
321 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
143 |
143 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
326 |
323 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
74 |
74 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
134 |
76 |
$831.65 |