KELLY, TIMOTHY
NPI: 1588653281
· RAPID CITY, SD 57702
· Dentist
· NPI assigned 10/17/2005
$810.24
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
14 |
$535.08 |
| 2019 |
12 |
$275.16 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14 |
14 |
$535.08 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$275.16 |