Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › MA › WEST ROXBURY › GUSTAVO PERDOMO DMD PC

GUSTAVO PERDOMO DMD PC

NPI: 1578042669 · WEST ROXBURY, MA 02132 · Dentist · NPI assigned 08/09/2018

$319.00
Total Medicaid Paid
12
Total Claims
12
Beneficiaries
1
Codes Billed
2023-09
First Month
2023-09
Last Month

Provider Details

Authorized OfficialSOARES, THIAGO (ADMINISTRATOR)
NPI Enumeration Date08/09/2018

Related Entities

Other providers sharing the same authorized official: SOARES, THIAGO

ProviderCityStateTotal Paid
RELIANT DENTAL GROUP PC WEST ROXBURY MA $724.00

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2023 12 $319.00

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D1208 Topical application of fluoride, excluding varnish 12 12 $319.00