Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › VA › ARLINGTON › CRYSTAL SMILE, PLLC

CRYSTAL SMILE, PLLC

NPI: 1639724461 · ARLINGTON, VA 22202 · General Practice Dentistry · NPI assigned 08/08/2019

$1K
Total Medicaid Paid
91
Total Claims
91
Beneficiaries
3
Codes Billed
2022-09
First Month
2023-12
Last Month

Provider Details

Authorized OfficialFAVAGEHI, JASON (PRESIDENT)
NPI Enumeration Date08/08/2019

Related Entities

Other providers sharing the same authorized official: FAVAGEHI, JASON

ProviderCityStateTotal Paid
JASON FARR FAVAGEHI DDS III PC CHANTILLY VA $34K
CRYSTAL CITY DENTAL ARTS CENTER ARLINGTON VA $13K
JASON FARR FAVAGEHI DDC PC VIENNA VA $12K
JASON F FAVAGEHI DDS PC ARLINGTON VA $3K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2022 13 $599.34
2023 78 $736.20

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D1110 Prophylaxis - adult 53 53 $1K
D0274 Bitewings - four radiographic images 26 26 $0.00
D0150 Comprehensive oral evaluation - new or established patient 12 12 $0.00