SCASSELLATI, JESSICA
NPI: 1528427176
· SPRINGFIELD, MO 65806
· Student in an Organized Health Care Education/Training Program
· NPI assigned 02/10/2016
$903.00
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
42 |
$903.00 |
Billing Codes
| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$337.00 |
| D0120 |
Periodic oral evaluation - established patient |
14 |
14 |
$294.00 |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$272.00 |