LCR DENTAL ROSE PARK LLC
NPI: 1558759514
· SALT LAKE CITY, UT 84116
· Dentist
· NPI assigned 12/29/2014
$220K
Total Medicaid Paid
Provider Details
Related Entities
Other providers sharing the same authorized official: ROMNEY, LAWRENCE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
798 |
$20K |
| 2019 |
567 |
$14K |
| 2020 |
122 |
$5K |
| 2021 |
2,080 |
$64K |
| 2022 |
1,629 |
$54K |
| 2023 |
955 |
$28K |
| 2024 |
1,202 |
$37K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,768 |
1,763 |
$116K |
| D1120 |
Prophylaxis - child |
1,802 |
1,791 |
$34K |
| D1206 |
Topical application of fluoride varnish |
2,282 |
2,271 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
202 |
200 |
$19K |
| D1351 |
Sealant - per tooth |
639 |
96 |
$17K |
| D0272 |
Bitewings - two radiographic images |
439 |
436 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
75 |
39 |
$3K |
| D0274 |
Bitewings - four radiographic images |
98 |
98 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$736.72 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$552.20 |