MANSFIELD FAMILY DENTAL, LLC

NPI: 1538623913 · MANSFIELD, MA 02048 · General Practice Dentistry · NPI assigned 01/30/2019

$101K

Total Medicaid Paid

1,278

Total Claims

1,224

Beneficiaries

Codes Billed

2023-03

First Month

2024-12

Last Month

Provider Details

Authorized Official	COSTA, MARDY (ADMINISTRATOR)
NPI Enumeration Date	01/30/2019

Other providers sharing the same authorized official: COSTA, MARDY

Provider	City	State	Total Paid
ALPHA DENTAL CENTER OF TAUNTON, LLC	TAUNTON	MA	$1.43M
ALPHA DENTAL CENTER OF TAUNTON, LLC	TAUNTON	MA	$165K
ALPHA DENTAL CENTER OF DARTMOUTH, LLC	N DARTMOUTH	MA	$40K
POCASSET FAMILY DENTAL, LLC	POCASSET	MA	$14K

Year	Claims	Total Paid
2023	390	$17K
2024	888	$84K

Code	Description	Claims	Beneficiaries	Total Paid
D2740	Crown - porcelain/ceramic	58	43	$41K
D1110	Prophylaxis - adult	566	565	$32K
D0120	Periodic oral evaluation - established patient	351	350	$9K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	95	65	$8K
D2950		30	25	$5K
D0150	Comprehensive oral evaluation - new or established patient	56	56	$2K
D0274	Bitewings - four radiographic images	67	67	$2K
D0210	Intraoral - complete series of radiographic images	25	25	$2K
D0220	Intraoral - periapical first radiographic image	30	28	$432.00