A SABBAGH-FARD DDS & P. MASTOUR DDS INC
NPI: 1568710333
· CULVER CITY, CA 90230
· Periodontist
· NPI assigned 08/27/2012
$256K
Total Medicaid Paid
Provider Details
| Authorized Official | MASTOUR, PEDRAM (DENTIST) |
| NPI Enumeration Date | 08/27/2012 |
Related Entities
Other providers sharing the same authorized official: MASTOUR, PEDRAM
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,081 |
$24K |
| 2019 |
626 |
$14K |
| 2020 |
1,397 |
$24K |
| 2021 |
1,934 |
$38K |
| 2022 |
1,681 |
$33K |
| 2023 |
2,294 |
$45K |
| 2024 |
2,161 |
$77K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
738 |
735 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
785 |
781 |
$46K |
| D0350 |
|
3,591 |
1,053 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
719 |
719 |
$33K |
| D4341 |
|
306 |
84 |
$21K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
41 |
26 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
366 |
365 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,542 |
836 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
347 |
347 |
$5K |
| D1206 |
Topical application of fluoride varnish |
176 |
176 |
$3K |
| D0274 |
Bitewings - four radiographic images |
120 |
120 |
$2K |
| D9430 |
|
40 |
40 |
$1K |
| D1320 |
|
57 |
57 |
$962.50 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$480.00 |
| D1999 |
|
146 |
143 |
$0.00 |
| D1330 |
|
188 |
188 |
$0.00 |