TEXAS WISDOM TEETH & DENTAL IMPLANTS
NPI: 1629428941
· DALLAS, TX 75254
· Oral and Maxillofacial Surgery (Dentist)
· NPI assigned 06/17/2016
$421K
Total Medicaid Paid
Provider Details
| Authorized Official | KOTLIAR, DAVID (MANAGER) |
| NPI Enumeration Date | 06/17/2016 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
241 |
$27K |
| 2021 |
2,514 |
$245K |
| 2022 |
1,479 |
$116K |
| 2023 |
711 |
$33K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
993 |
341 |
$274K |
| D0330 |
Panoramic radiographic image |
855 |
850 |
$51K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,109 |
535 |
$39K |
| D9222 |
|
536 |
534 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
873 |
868 |
$16K |
| D9612 |
|
310 |
306 |
$10K |
| D9219 |
|
80 |
80 |
$1K |
| D9630 |
|
154 |
153 |
$714.20 |
| D9610 |
|
12 |
12 |
$107.52 |
| D7921 |
|
23 |
12 |
$0.00 |