SOUTH LOUISVILLE DENTAL SPECIALISTS INC
NPI: 1548259377
· LOUISVILLE, KY 40214
· Dentist
· NPI assigned 10/14/2005
$404K
Total Medicaid Paid
Provider Details
| Authorized Official | WICKSON, ARTHUR (CO-OWNER) |
| NPI Enumeration Date | 10/14/2005 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
141 |
$31K |
| 2022 |
968 |
$171K |
| 2023 |
891 |
$138K |
| 2024 |
983 |
$65K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
82 |
79 |
$152K |
| D8670 |
Periodic orthodontic treatment visit |
123 |
120 |
$106K |
| D0330 |
Panoramic radiographic image |
1,275 |
1,255 |
$57K |
| D8999 |
|
86 |
81 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
857 |
844 |
$19K |
| D0340 |
|
305 |
299 |
$17K |
| D9996 |
|
32 |
29 |
$1K |
| D9986 |
|
223 |
213 |
$642.00 |