WESTSIDE SMILE DENTAL LLC
NPI: 1588805626
· SEATTLE, WA 98106
· Denturist
· NPI assigned 03/19/2009
$303.79
Total Medicaid Paid
Provider Details
| Authorized Official | VONG, PHONG (DENTURIST) |
| NPI Enumeration Date | 03/19/2009 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
52 |
$303.79 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$153.42 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
14 |
$106.96 |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
14 |
$43.41 |