SOUTHERN SMILES, PA
NPI: 1669159299
· ROSHARON, TX 77583
· Dental Clinic/Center
· NPI assigned 07/05/2023
$341.82
Total Medicaid Paid
Provider Details
| Authorized Official | PHAM, PHI (FOUNDER) |
| NPI Enumeration Date | 07/05/2023 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2024 |
26 |
$341.82 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$191.10 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$150.72 |