MAINE DENTAL HEALTH OUT-REACH, INC
NPI: 1669607644
· WINTHROP, ME 04364
· Dental Hygienist
· NPI assigned 05/20/2009
$379K
Total Medicaid Paid
Provider Details
| Authorized Official | LAVALLEE, SUSANNE (PRESIDENT/DIRECTOR) |
| NPI Enumeration Date | 05/20/2009 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
3,811 |
$62K |
| 2019 |
3,716 |
$61K |
| 2020 |
2,088 |
$46K |
| 2021 |
1,710 |
$37K |
| 2022 |
278 |
$8K |
| 2023 |
2,621 |
$74K |
| 2024 |
2,932 |
$91K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
4,176 |
413 |
$105K |
| D1351 |
Sealant - per tooth |
4,552 |
582 |
$67K |
| D2940 |
|
834 |
105 |
$50K |
| D1355 |
|
2,299 |
146 |
$45K |
| D1120 |
Prophylaxis - child |
781 |
773 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,463 |
1,423 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
212 |
207 |
$12K |
| D1110 |
Prophylaxis - adult |
249 |
248 |
$11K |
| D1330 |
|
830 |
823 |
$10K |
| D0274 |
Bitewings - four radiographic images |
341 |
339 |
$8K |
| D1206 |
Topical application of fluoride varnish |
561 |
559 |
$7K |
| D1310 |
|
217 |
213 |
$6K |
| D0190 |
|
279 |
276 |
$6K |
| D0272 |
Bitewings - two radiographic images |
240 |
239 |
$5K |
| D0191 |
|
122 |
120 |
$2K |