SUN WEST DENTAL CENTER III, LLC
NPI: 1669515300
· BUCKEYE, AZ 85326
· Dentist
· NPI assigned 02/14/2007
$777.00
Total Medicaid Paid
Provider Details
| Authorized Official | DALTON, TRACEY (CREDENTIALING SPECIALIST) |
| Parent Organization | SUN WEST DENTAL CENTER III, LLC |
| NPI Enumeration Date | 02/14/2007 |
Related Entities
Other providers sharing the same authorized official: DALTON, TRACEY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
142 |
$0.00 |
| 2019 |
403 |
$401.00 |
| 2020 |
273 |
$376.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
485 |
426 |
$370.00 |
| D0140 |
Limited oral evaluation - problem focused |
110 |
102 |
$200.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
172 |
146 |
$96.00 |
| D0274 |
Bitewings - four radiographic images |
39 |
37 |
$92.00 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$19.00 |