STATE OF DELAWARE
NPI: 1598837361
· DOVER, DE 19901
· Dental Clinic/Center
· NPI assigned 11/15/2006
$148K
Total Medicaid Paid
Provider Details
| Authorized Official | MCCLURE, GREGORY (DENTAL DIRECTOR) |
| NPI Enumeration Date | 11/15/2006 |
Related Entities
Other providers sharing the same authorized official: MCCLURE, GREGORY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,366 |
$53K |
| 2019 |
1,760 |
$72K |
| 2020 |
604 |
$24K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
718 |
716 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
466 |
465 |
$33K |
| D1206 |
Topical application of fluoride varnish |
916 |
913 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
293 |
292 |
$12K |
| D0274 |
Bitewings - four radiographic images |
196 |
196 |
$11K |
| D0272 |
Bitewings - two radiographic images |
254 |
251 |
$10K |
| D0330 |
Panoramic radiographic image |
42 |
42 |
$4K |
| D1110 |
Prophylaxis - adult |
57 |
55 |
$4K |
| D1351 |
Sealant - per tooth |
41 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$312.12 |
| D0603 |
|
603 |
600 |
$0.00 |
| D0602 |
|
132 |
132 |
$0.00 |