CROFOOT, BO
NPI: 1669532230
· REXBURG, ID 83440
· General Practice Dentistry
· NPI assigned 12/12/2006
$741.54
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
27 |
$741.54 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
12 |
12 |
$741.54 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$0.00 |