NPI: 1679093264 · GREENVILLE, SC 29607 · Student in an Organized Health Care Education/Training Program · NPI assigned 06/23/2017
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 92 | $3K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 13 | 13 | $570.44 |
| D0120 | Periodic oral evaluation - established patient | 24 | 24 | $545.60 |
| D1206 | Topical application of fluoride varnish | 25 | 25 | $512.50 |
| D1120 | Prophylaxis - child | 14 | 14 | $477.82 |
| D0274 | Bitewings - four radiographic images | 16 | 16 | $421.24 |