NPI: 1700095957 · RATHDRUM, ID 83858 · Dentist · NPI assigned 05/22/2007
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 749 | $22K |
| 2022 | 212 | $8K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 270 | 270 | $19K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 127 | 58 | $6K |
| D1120 | Prophylaxis - child | 43 | 43 | $3K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 40 | 26 | $509.13 |
| D0274 | Bitewings - four radiographic images | 123 | 123 | $172.24 |
| D0120 | Periodic oral evaluation - established patient | 183 | 183 | $130.11 |
| D1208 | Topical application of fluoride, excluding varnish | 175 | 175 | $13.55 |