NPI: 1548886492 · MISSOURI CITY, TX 77459 · General Practice Dentistry · NPI assigned 06/17/2020
| Year | Claims | Total Paid |
|---|---|---|
| 2022 | 103 | $584.58 |
| 2023 | 143 | $3K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0145 | Oral evaluation for a patient under three years of age | 13 | 13 | $2K |
| D0230 | Intraoral - periapical each additional radiographic image | 58 | 26 | $575.50 |
| D0120 | Periodic oral evaluation - established patient | 14 | 14 | $403.90 |
| D1208 | Topical application of fluoride, excluding varnish | 28 | 26 | $382.20 |
| D0220 | Intraoral - periapical first radiographic image | 31 | 29 | $351.68 |
| D0601 | 89 | 85 | $0.00 | |
| D0603 | 13 | 13 | $0.00 |