JACKSON, ANDREA
NPI: 1578707204
· CLINTON, MD 20735
· Prosthodontist
· NPI assigned 04/24/2009
$928.35
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
28 |
$928.35 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15 |
15 |
$578.07 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$350.28 |