G & M DENTAL CORPORATION
NPI: 1578223582
· UPLAND, CA 91786
· Dentist
· NPI assigned 12/20/2021
$104K
Total Medicaid Paid
Provider Details
| Authorized Official | MANALO, ROSELYN (CREDENTIALING COORDINATOR) |
| NPI Enumeration Date | 12/20/2021 |
Related Entities
Other providers sharing the same authorized official: MANALO, ROSELYN
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
397 |
$8K |
| 2023 |
2,607 |
$55K |
| 2024 |
1,172 |
$41K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
497 |
492 |
$32K |
| D2740 |
Crown - porcelain/ceramic |
39 |
26 |
$19K |
| D1110 |
Prophylaxis - adult |
187 |
187 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,373 |
438 |
$10K |
| D0274 |
Bitewings - four radiographic images |
381 |
380 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
410 |
410 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
109 |
109 |
$5K |
| D4341 |
|
49 |
14 |
$3K |
| D1120 |
Prophylaxis - child |
54 |
54 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
30 |
28 |
$2K |
| D4910 |
|
12 |
12 |
$770.00 |
| D0350 |
|
35 |
15 |
$336.00 |