QUILEUTE TRIBAL COUNCIL
NPI: 1518425511
· LA PUSH, WA 98350
· Dental Clinic/Center
· NPI assigned 03/08/2019
$1.01M
Total Medicaid Paid
Provider Details
| Authorized Official | GOODWIN, GARY (BILLING AGENCY) |
| Parent Organization | QUILEUTE TRIBAL COUNCIL |
| NPI Enumeration Date | 03/08/2019 |
Related Entities
Other providers sharing the same authorized official: GOODWIN, GARY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
806 |
$144K |
| 2020 |
328 |
$69K |
| 2021 |
57 |
$20K |
| 2022 |
439 |
$118K |
| 2023 |
1,882 |
$358K |
| 2024 |
1,171 |
$304K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,242 |
1,854 |
$980K |
| D0120 |
Periodic oral evaluation - established patient |
444 |
441 |
$11K |
| D1206 |
Topical application of fluoride varnish |
566 |
563 |
$9K |
| D1110 |
Prophylaxis - adult |
159 |
159 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
100 |
96 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
241 |
237 |
$2K |
| D0274 |
Bitewings - four radiographic images |
141 |
140 |
$2K |
| D1354 |
|
288 |
61 |
$1K |
| D0330 |
Panoramic radiographic image |
21 |
21 |
$688.39 |
| D1120 |
Prophylaxis - child |
29 |
29 |
$574.48 |
| D0230 |
Intraoral - periapical each additional radiographic image |
147 |
116 |
$307.50 |
| D1351 |
Sealant - per tooth |
14 |
14 |
$175.84 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$123.48 |
| D0190 |
|
221 |
188 |
$0.00 |
| D0191 |
|
57 |
56 |
$0.00 |