SANTAN KIDTASTIC LLC
NPI: 1669726030
· SAN TAN VALLEY, AZ 85143
· Pediatric Dentist
· NPI assigned 11/06/2012
Provider Details
| Authorized Official | JOHNSON, JAIME (CONTROLL) |
| NPI Enumeration Date | 11/06/2012 |
Related Entities
Other providers sharing the same authorized official: JOHNSON, JAIME
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
402 |
$6K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
156 |
134 |
$2K |
| D1120 |
Prophylaxis - child |
76 |
59 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$546.60 |
| D0120 |
Periodic oral evaluation - established patient |
22 |
22 |
$515.24 |
| D0220 |
Intraoral - periapical first radiographic image |
51 |
46 |
$351.60 |
| D0240 |
|
24 |
18 |
$339.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
33 |
$327.42 |
| D0272 |
Bitewings - two radiographic images |
22 |
22 |
$244.66 |