SPARTA FAMILY DENTISTRY PLLC
NPI: 1497493258
· SPARTA, MI 49345
· Dental Clinic/Center
· NPI assigned 05/23/2022
Provider Details
| Authorized Official | GOODYKE, AUSTIN (DENTIST/OWNER) |
| NPI Enumeration Date | 05/23/2022 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
24 |
$586.31 |
| 2024 |
77 |
$2K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
52 |
52 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
36 |
36 |
$965.50 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$441.06 |