NPI: 1508353731 · SALT LAKE CITY, UT 84132 · Student in an Organized Health Care Education/Training Program · NPI assigned 04/13/2018
| Year | Claims | Total Paid |
|---|---|---|
| 2020 | 87 | $5K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0150 | Comprehensive oral evaluation - new or established patient | 35 | 35 | $3K |
| D1120 | Prophylaxis - child | 13 | 13 | $696.37 |
| D0330 | Panoramic radiographic image | 12 | 12 | $519.71 |
| D0274 | Bitewings - four radiographic images | 13 | 13 | $506.15 |
| D1206 | Topical application of fluoride varnish | 14 | 14 | $0.00 |