CHILDREN'S SMILE CENTER
NPI: 1629403027
· AURORA, MO 65605
· Dentist
· NPI assigned 09/05/2013
$821.89
Total Medicaid Paid
Provider Details
| Authorized Official | BARGER, JACKIE (EXECUTIVE DIRECTOR) |
| NPI Enumeration Date | 09/05/2013 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
62 |
$821.89 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
37 |
37 |
$458.49 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$259.56 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$103.84 |