PURE SMILE DENTAL GROUP
NPI: 1609141274
· SOUTH SAN FRANCISCO, CA 94080
· Dental Clinic/Center
· NPI assigned 03/15/2012
Provider Details
| Authorized Official | KOTROB, MOUTAZ (OWNER) |
| NPI Enumeration Date | 03/15/2012 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2024 |
634 |
$41K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
81 |
81 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
101 |
101 |
$7K |
| D1999 |
|
84 |
81 |
$7K |
| D4341 |
|
77 |
24 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
91 |
91 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
61 |
24 |
$5K |
| D1206 |
Topical application of fluoride varnish |
63 |
63 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$265.10 |
| D0350 |
|
62 |
62 |
$0.00 |