4TH AVENUE DENTAL, PA, DBA OAK PARK DENTAL
NPI: 1609298355
· PINE CITY, MN 55063
· General Practice Dentistry
· NPI assigned 01/15/2014
Provider Details
| Authorized Official | ASCHEMAN, ALICIA (SUPERVISOR/OWNER) |
| NPI Enumeration Date | 01/15/2014 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
107 |
$3K |
| 2020 |
91 |
$3K |
| 2021 |
33 |
$907.04 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
89 |
89 |
$3K |
| D1206 |
Topical application of fluoride varnish |
105 |
105 |
$3K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$554.80 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$467.56 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$378.84 |