SAN GABRIEL VALLEY FOUNDATION FOR DENTAL HEALTH
NPI: 1700189495
· LA PUENTE, CA 91746
· Pediatric Dentist
· NPI assigned 12/18/2010
$474.00
Total Medicaid Paid
Provider Details
| Authorized Official | CONTINO, SONDRA (DIRECTOR) |
| NPI Enumeration Date | 12/18/2010 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
44 |
$474.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14 |
13 |
$360.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
14 |
$114.00 |
| D1330 |
|
15 |
13 |
$0.00 |