LEGACY DENTAL LLC
NPI: 1679175541
· ERIE, PA 16506
· Public Health Dentist
· NPI assigned 11/14/2020
Provider Details
| Authorized Official | MANSOUR, SAMER (DENTIST) |
| NPI Enumeration Date | 11/14/2020 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
91 |
$2K |
| 2024 |
352 |
$13K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
192 |
191 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
187 |
187 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
38 |
37 |
$677.40 |
| D1206 |
Topical application of fluoride varnish |
26 |
26 |
$628.64 |