MAIN STREET DENTAL PLLC
NPI: 1679215818
· OLIVET, MI 49076
· Dentist
· NPI assigned 04/08/2022
Provider Details
| Authorized Official | LEWIS, LANA (MEMBER) |
| NPI Enumeration Date | 04/08/2022 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
53 |
$1K |
| 2023 |
25 |
$480.00 |
| 2024 |
18 |
$423.50 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
71 |
71 |
$2K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$462.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$275.00 |