MITCHELL DENTAL CLINIC LLC
NPI: 1629284401
· MITCHELL, SD 57301
· Dentist
· NPI assigned 05/16/2007
$106K
Total Medicaid Paid
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
354 |
$15K |
| 2019 |
415 |
$18K |
| 2020 |
229 |
$10K |
| 2021 |
373 |
$14K |
| 2022 |
398 |
$16K |
| 2023 |
427 |
$18K |
| 2024 |
295 |
$15K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,085 |
1,072 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,131 |
1,120 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
181 |
180 |
$5K |
| D9920 |
|
46 |
41 |
$5K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$440.16 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
16 |
$251.25 |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
13 |
$213.29 |