STATE STREET FAMILY DENTAL
NPI: 1669604484
· SAINT JOHNS, MI 48879
· Dentist
· NPI assigned 08/12/2009
$148K
Total Medicaid Paid
Provider Details
Related Entities
Other providers sharing the same authorized official: OSBORNE, JENNIFER
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
717 |
$27K |
| 2021 |
1,391 |
$57K |
| 2022 |
836 |
$27K |
| 2023 |
741 |
$20K |
| 2024 |
549 |
$16K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
827 |
827 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,187 |
1,187 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
238 |
151 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,164 |
1,164 |
$27K |
| D1110 |
Prophylaxis - adult |
298 |
298 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
26 |
$3K |
| D0274 |
Bitewings - four radiographic images |
91 |
91 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
54 |
$2K |
| D0240 |
|
116 |
58 |
$2K |
| D0272 |
Bitewings - two radiographic images |
87 |
87 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
38 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
101 |
99 |
$2K |