SUN WEST DENTAL III, LLC DBA SUN WEST DENTAL
NPI: 1699817213
· CHANDLER, AZ 85224
· Dental Clinic/Center
· NPI assigned 02/12/2007
$110.00
Total Medicaid Paid
Provider Details
| Authorized Official | DALTON, TRACEY (CREDENTIALING SPECIALIST) |
| Parent Organization | SUNWEST DENTAL CENTER III, LLC |
| NPI Enumeration Date | 02/12/2007 |
Related Entities
Other providers sharing the same authorized official: DALTON, TRACEY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
45 |
$0.00 |
| 2019 |
155 |
$110.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
118 |
110 |
$110.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
29 |
29 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
28 |
28 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$0.00 |