PEDERSEN, KYLE
NPI: 1619092905
· ST CHARLES, IL 60174
· Pediatric Dentist
· NPI assigned 03/19/2007
$414.74
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
66 |
$0.00 |
| 2022 |
480 |
$414.74 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
148 |
143 |
$218.34 |
| D1206 |
Topical application of fluoride varnish |
192 |
185 |
$196.40 |
| D0272 |
Bitewings - two radiographic images |
39 |
38 |
$0.00 |
| D1120 |
Prophylaxis - child |
92 |
89 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
31 |
29 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
19 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
25 |
24 |
$0.00 |