COUNTRYSIDE MALL DENTAL PA
NPI: 1568023067
· CLEARWATER, FL 33761
· 1223G0001X
$155K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
301 |
$4K |
| 2021 |
2,196 |
$20K |
| 2022 |
4,846 |
$50K |
| 2023 |
5,260 |
$69K |
| 2024 |
1,043 |
$12K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
|
1,804 |
1,789 |
$87K |
| D0120 |
|
342 |
339 |
$14K |
| D1110 |
|
660 |
654 |
$14K |
| D2391 |
|
392 |
217 |
$11K |
| D0140 |
|
493 |
450 |
$9K |
| D2392 |
|
138 |
101 |
$5K |
| D7210 |
|
79 |
25 |
$3K |
| D0210 |
|
51 |
51 |
$3K |
| D0330 |
|
1,883 |
1,869 |
$2K |
| D1208 |
|
876 |
859 |
$2K |
| D9310 |
|
24 |
24 |
$1K |
| D1330 |
|
1,754 |
1,635 |
$1K |
| D0272 |
|
1,572 |
1,558 |
$1K |
| D4355 |
|
51 |
51 |
$985.92 |
| D0220 |
|
1,743 |
1,727 |
$828.36 |
| D9999 |
|
14 |
14 |
$280.00 |
| D4346 |
|
27 |
27 |
$111.61 |
| D0230 |
|
1,646 |
1,630 |
$107.80 |
| D1120 |
|
33 |
33 |
$36.00 |
| D4921 |
|
64 |
56 |
$0.00 |