PONY EXPRESS DENTAL LLC
NPI: 1609315480
· EAGLE MOUNTAIN, UT 84005
· Dental Clinic/Center
· NPI assigned 02/14/2017
Provider Details
| Authorized Official | TORNOW, MICHAEL (COO) |
| Parent Organization | LAKE MOUNTAIN HEALTH, LLC |
| NPI Enumeration Date | 02/14/2017 |
Related Entities
Other providers sharing the same authorized official: TORNOW, MICHAEL
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
332 |
$3K |
| 2022 |
68 |
$352.29 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
114 |
107 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
58 |
56 |
$104.83 |
| D1120 |
Prophylaxis - child |
46 |
44 |
$80.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
157 |
74 |
$35.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |