DENTAL AND BRACES MESA LLC
NPI: 1659835932
· MESA, AZ 85204
· Health Service Clinic/Center
· NPI assigned 01/30/2019
Provider Details
| Authorized Official | RAMOS, LIZ (MANAGER) |
| NPI Enumeration Date | 01/30/2019 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
160 |
$4K |
| 2023 |
196 |
$3K |
| 2024 |
682 |
$3K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
538 |
526 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
177 |
173 |
$3K |
| D0330 |
Panoramic radiographic image |
97 |
97 |
$2K |
| D0274 |
Bitewings - four radiographic images |
133 |
131 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
14 |
14 |
$286.22 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
14 |
$0.00 |
| D1110 |
Prophylaxis - adult |
57 |
57 |
$0.00 |