JD KIM PROFESSIONAL DENTAL CORP.
NPI: 1679131478
· POMONA, CA 91768
· General Practice Dentistry
· NPI assigned 06/05/2019
$112K
Total Medicaid Paid
Provider Details
| Authorized Official | KIM, JOO HYUNG (CEO/DENTIST) |
| NPI Enumeration Date | 06/05/2019 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
67 |
$4K |
| 2021 |
44 |
$3K |
| 2022 |
685 |
$18K |
| 2023 |
1,361 |
$42K |
| 2024 |
1,389 |
$44K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
724 |
715 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
445 |
438 |
$18K |
| D0350 |
|
1,228 |
616 |
$16K |
| D0330 |
Panoramic radiographic image |
411 |
411 |
$12K |
| D1120 |
Prophylaxis - child |
91 |
91 |
$5K |
| D1110 |
Prophylaxis - adult |
57 |
57 |
$5K |
| D1206 |
Topical application of fluoride varnish |
298 |
298 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
144 |
125 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$925.00 |
| D0220 |
Intraoral - periapical first radiographic image |
79 |
79 |
$916.00 |
| D9430 |
|
25 |
24 |
$800.00 |
| D0274 |
Bitewings - four radiographic images |
32 |
32 |
$604.80 |