PORTAL DENTAL PASADENA PLLC
NPI: 1588345375
· PASADENA, TX 77504
· General Practice Dentistry
· NPI assigned 07/26/2023
$507.23
Total Medicaid Paid
Provider Details
Related Entities
Other providers sharing the same authorized official: REINHOLTZ, GABRIELA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2024 |
85 |
$507.23 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
30 |
26 |
$227.24 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
12 |
$176.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
12 |
$103.59 |
| D0603 |
|
13 |
12 |
$0.00 |
| D9986 |
|
13 |
13 |
$0.00 |