SOUTHEAST MISSOURI HEALTH NETWORK
NPI: 1598069247
· BERNIE, MO 63822
· General Practice Dentistry
· NPI assigned 01/10/2011
$227K
Total Medicaid Paid
Provider Details
| Authorized Official | DEANE, SARA (CHIEF FINANCIAL OFFICER) |
| NPI Enumeration Date | 01/10/2011 |
Related Entities
Other providers sharing the same authorized official: DEANE, SARA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,238 |
$117K |
| 2019 |
700 |
$63K |
| 2020 |
195 |
$16K |
| 2021 |
211 |
$20K |
| 2022 |
65 |
$5K |
| 2024 |
52 |
$4K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
936 |
229 |
$111K |
| D0330 |
Panoramic radiographic image |
340 |
327 |
$34K |
| D1110 |
Prophylaxis - adult |
386 |
358 |
$34K |
| D0274 |
Bitewings - four radiographic images |
413 |
400 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
231 |
213 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
76 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
58 |
56 |
$2K |
| D1206 |
Topical application of fluoride varnish |
19 |
19 |
$985.32 |