OCEAN SMILE DENTAL

NPI: 1619313921 · HUNTINGTON BEACH, CA 92646 · General Practice Dentistry · NPI assigned 05/14/2013

$9K

Total Medicaid Paid

475

Total Claims

380

Beneficiaries

Codes Billed

2018-01

First Month

2018-07

Last Month

Provider Details

Authorized Official	NGUYEN, RICHARD (GENERAL PARTNER)
NPI Enumeration Date	05/14/2013

Other providers sharing the same authorized official: NGUYEN, RICHARD

Provider	City	State	Total Paid
ZINFANDEL DENTAL PRACTICE	SACRAMENTO	CA	$4.60M
BUENA VISTA FAMILY MEDICAL CENTER, INC.	OXNARD	CA	$1.14M
ZINFANDEL DENTAL PRACTICE	RANCHO CORDOVA	CA	$787K
PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - HONOLULU, LLC	HONOLULU	HI	$4K
SC DENTAL	WESTMINSTER	CA	$743.55

Year	Claims	Total Paid
2018	475	$9K

Code	Description	Claims	Beneficiaries	Total Paid
D0150	Comprehensive oral evaluation - new or established patient	64	64	$2K
D1120	Prophylaxis - child	77	76	$2K
D0120	Periodic oral evaluation - established patient	70	70	$1K
D0210	Intraoral - complete series of radiographic images	25	25	$1K
D1208	Topical application of fluoride, excluding varnish	89	88	$746.00
D0230	Intraoral - periapical each additional radiographic image	137	44	$414.00
D0274	Bitewings - four radiographic images	13	13	$216.00