ABC123 PEDIATRIC DENTISTRY, PA
NPI: 1699914705
· PEARLAND, TX 77584
· Pediatric Dentist
· NPI assigned 02/12/2009
$117K
Total Medicaid Paid
Provider Details
| Authorized Official | DIAZ, IVETTE (PEDIATRIC DENTIST) |
| NPI Enumeration Date | 02/12/2009 |
Related Entities
Other providers sharing the same authorized official: DIAZ, IVETTE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
50 |
$0.00 |
| 2021 |
829 |
$15K |
| 2022 |
2,645 |
$56K |
| 2023 |
1,357 |
$27K |
| 2024 |
1,268 |
$19K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
196 |
191 |
$27K |
| D1120 |
Prophylaxis - child |
668 |
639 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
612 |
586 |
$17K |
| D0272 |
Bitewings - two radiographic images |
572 |
543 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
869 |
820 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
939 |
771 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
645 |
611 |
$9K |
| D1351 |
Sealant - per tooth |
197 |
45 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
76 |
66 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
24 |
14 |
$515.09 |
| D9986 |
|
17 |
16 |
$0.00 |
| D1999 |
|
62 |
57 |
$0.00 |
| D0603 |
|
1,166 |
1,131 |
$0.00 |
| D0602 |
|
13 |
12 |
$0.00 |
| D1330 |
|
64 |
61 |
$0.00 |