ROBERT BOOTEHSAZ DMD INC
NPI: 1689087199
· TARZANA, CA 91356
· Dental Clinic/Center
· NPI assigned 06/03/2014
$158K
Total Medicaid Paid
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
143 |
$3K |
| 2019 |
387 |
$12K |
| 2020 |
781 |
$15K |
| 2021 |
814 |
$16K |
| 2022 |
954 |
$26K |
| 2023 |
1,353 |
$49K |
| 2024 |
885 |
$38K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
632 |
631 |
$43K |
| D1110 |
Prophylaxis - adult |
468 |
468 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,536 |
1,530 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,698 |
576 |
$12K |
| D4910 |
|
121 |
121 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
132 |
128 |
$8K |
| D9430 |
|
238 |
199 |
$7K |
| D0274 |
Bitewings - four radiographic images |
294 |
294 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
90 |
$4K |
| D1120 |
Prophylaxis - child |
53 |
53 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
52 |
49 |
$690.00 |