VICTUS DENTAL III PA
NPI: 1588312268
· PENSACOLA, FL 32514
· Dental Clinic/Center
· NPI assigned 03/12/2022
$163K
Total Medicaid Paid
Provider Details
| Authorized Official | LE, ANTHONY (PRESIDENT) |
| NPI Enumeration Date | 03/12/2022 |
Related Entities
Other providers sharing the same authorized official: LE, ANTHONY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
1,626 |
$89K |
| 2024 |
5,022 |
$74K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
440 |
218 |
$83K |
| D9420 |
|
536 |
530 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
963 |
389 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
975 |
384 |
$90.96 |
| D1206 |
Topical application of fluoride varnish |
531 |
525 |
$0.00 |
| D1330 |
|
531 |
525 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,130 |
347 |
$0.00 |
| D1351 |
Sealant - per tooth |
308 |
114 |
$0.00 |
| D2330 |
|
46 |
24 |
$0.00 |
| D9310 |
|
18 |
18 |
$0.00 |
| D1120 |
Prophylaxis - child |
532 |
526 |
$0.00 |
| D0350 |
|
533 |
527 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
105 |
69 |
$0.00 |