LITTLE BIG SMILES, LLC
NPI: 1609249804
· RAYTOWN, MO 64133
· Dental Clinic/Center
· NPI assigned 11/10/2015
$903.52
Total Medicaid Paid
Provider Details
| Authorized Official | WILSON, BENJAMIN (OWNER/DENTIST) |
| NPI Enumeration Date | 11/10/2015 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
12 |
$116.30 |
| 2019 |
69 |
$787.22 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
45 |
43 |
$390.04 |
| D0120 |
Periodic oral evaluation - established patient |
19 |
16 |
$272.03 |
| D1120 |
Prophylaxis - child |
17 |
16 |
$241.45 |