CHILDRENS DENTAL COUNCIL BLUFFS LLC
NPI: 1558139170
· COUNCIL BLUFFS, IA 51503
· Pediatric Dentist
· NPI assigned 12/13/2023
$723.72
Total Medicaid Paid
Provider Details
| Authorized Official | MYERS, LYNN (INSURANCE MANAGER) |
| NPI Enumeration Date | 12/13/2023 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2024 |
25 |
$723.72 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12 |
12 |
$448.88 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$274.84 |