NPI: 1588232052 · WILMETTE, IL 60091 · Dentist · NPI assigned 06/11/2021
| Year | Claims | Total Paid |
|---|---|---|
| 2024 | 861 | $23K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 163 | 162 | $7K |
| D1351 | Sealant - per tooth | 46 | 29 | $5K |
| D1208 | Topical application of fluoride, excluding varnish | 162 | 161 | $4K |
| D0120 | Periodic oral evaluation - established patient | 117 | 116 | $3K |
| D0230 | Intraoral - periapical each additional radiographic image | 159 | 159 | $1K |
| D0220 | Intraoral - periapical first radiographic image | 165 | 165 | $1K |
| D0274 | Bitewings - four radiographic images | 35 | 35 | $518.44 |
| D0150 | Comprehensive oral evaluation - new or established patient | 14 | 14 | $365.12 |