JACK SHABANIAN, D.D.S. INC.
NPI: 1538249222
· HAWTHORNE, CA 90250
· Dentist
· NPI assigned 10/17/2006
$221K
Total Medicaid Paid
Provider Details
| Authorized Official | SHABANIAN, JACK (PRESIDENT) |
| NPI Enumeration Date | 10/17/2006 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,787 |
$29K |
| 2019 |
1,351 |
$24K |
| 2020 |
615 |
$10K |
| 2021 |
1,076 |
$21K |
| 2022 |
1,419 |
$32K |
| 2023 |
2,092 |
$57K |
| 2024 |
1,612 |
$47K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
808 |
807 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
727 |
727 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
501 |
500 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,630 |
1,629 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,803 |
1,502 |
$19K |
| D0274 |
Bitewings - four radiographic images |
433 |
433 |
$9K |
| D1120 |
Prophylaxis - child |
198 |
198 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
560 |
542 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
132 |
132 |
$6K |
| D4910 |
|
69 |
69 |
$5K |
| D9430 |
|
91 |
90 |
$3K |