NPI: 1689716508 · SURPRISE, AZ 85374 · Dentist · NPI assigned 02/14/2007
| Authorized Official | DALTON, TRACEY (DIRECTOR OF ADMINISTRATION) |
| NPI Enumeration Date | 02/14/2007 |
Other providers sharing the same authorized official: DALTON, TRACEY
| Provider | City | State | Total Paid |
|---|---|---|---|
| SUNWEST DENTAL CENTER III, LLC | TEMPE | AZ | $12K |
| SUN WEST DENTAL III, LLC | APACHE JUNCTION | AZ | $3K |
| SUN WEST DENTAL SAN TAN | SAN TAN VALLEY | AZ | $2K |
| SUNWEST DENTAL CENTER, III LLC | PRESCOTT VALLEY | AZ | $1K |
| SUN WEST DENTAL CENTER III, LLC | BUCKEYE | AZ | $777.00 |
| TEMPE SMILES FAMILY DENTAL, PC | TEMPE | AZ | $541.64 |
| SUN WEST DENTAL III, LLC DBA SUN WEST DENTAL | CHANDLER | AZ | $110.00 |
| SUN WEST DENTAL III, LLC | MESA | AZ | $40.00 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 1,061 | $13K |
| 2019 | 979 | $16K |
| 2020 | 1,165 | $11K |
| 2021 | 857 | $9K |
| 2022 | 520 | $5K |
| 2023 | 128 | $1K |
| 2024 | 89 | $591.56 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0140 | Limited oral evaluation - problem focused | 946 | 908 | $19K |
| D0220 | Intraoral - periapical first radiographic image | 2,284 | 2,168 | $15K |
| D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | 177 | 66 | $11K |
| D0230 | Intraoral - periapical each additional radiographic image | 952 | 853 | $4K |
| D0274 | Bitewings - four radiographic images | 155 | 152 | $2K |
| D0330 | Panoramic radiographic image | 58 | 56 | $2K |
| D0120 | Periodic oral evaluation - established patient | 64 | 64 | $985.10 |
| D1110 | Prophylaxis - adult | 36 | 36 | $718.96 |
| D1206 | Topical application of fluoride varnish | 79 | 78 | $415.28 |
| D0150 | Comprehensive oral evaluation - new or established patient | 15 | 15 | $291.48 |
| D1208 | Topical application of fluoride, excluding varnish | 14 | 14 | $178.78 |
| D1999 | 19 | 14 | $3.00 |