THUNDER BAY COMMUNITY HEALTH SERVICE, INC
NPI: 1609435536
· ROGERS CITY, MI 49779
· Federally Qualified Health Center (FQHC)
· NPI assigned 06/13/2019
Provider Details
| Authorized Official | BOLANOWSKI, HEIDE (CREDENTIALING SPECIALIST) |
| NPI Enumeration Date | 06/13/2019 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
189 |
$5K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
55 |
14 |
$1K |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$900.00 |
| D1354 |
|
36 |
12 |
$850.00 |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$702.00 |
| D0120 |
Periodic oral evaluation - established patient |
24 |
24 |
$672.00 |
| D1206 |
Topical application of fluoride varnish |
22 |
22 |
$525.00 |
| D1120 |
Prophylaxis - child |
14 |
14 |
$520.00 |