NPI: 1568841484 · GUAYAMA, PR 00784 · General Practice Dentistry · NPI assigned 05/26/2015
| Authorized Official | DOMINGUEZ REVERON, IVELISSE (PRESIDENT) |
| NPI Enumeration Date | 05/26/2015 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 53 | $1K |
| 2019 | 369 | $6K |
| 2021 | 62 | $638.44 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0150 | Comprehensive oral evaluation - new or established patient | 161 | 95 | $3K |
| D1110 | Prophylaxis - adult | 105 | 60 | $2K |
| D1208 | Topical application of fluoride, excluding varnish | 60 | 26 | $830.74 |
| D1999 | 62 | 60 | $638.44 | |
| D1120 | Prophylaxis - child | 33 | 12 | $574.40 |
| D0120 | Periodic oral evaluation - established patient | 41 | 17 | $465.78 |
| D0272 | Bitewings - two radiographic images | 22 | 12 | $302.90 |