NPI: 1508999053 · CALEDONIA, MI 49316 · General Practice Dentistry · NPI assigned 03/13/2007
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 742 | $20K |
| 2019 | 470 | $13K |
| 2020 | 123 | $3K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 583 | 583 | $14K |
| D1120 | Prophylaxis - child | 356 | 356 | $12K |
| D1206 | Topical application of fluoride varnish | 331 | 331 | $7K |
| D1351 | Sealant - per tooth | 29 | 13 | $755.70 |
| D1110 | Prophylaxis - adult | 12 | 12 | $594.00 |
| D0274 | Bitewings - four radiographic images | 12 | 12 | $385.00 |
| D0272 | Bitewings - two radiographic images | 12 | 12 | $240.00 |