NPI: 1710961495 · WHEATON, MN 56296 · General Practice Dentistry · NPI assigned 12/06/2005
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 458 | $2K |
| 2019 | 511 | $16K |
| 2020 | 449 | $12K |
| 2021 | 478 | $15K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 641 | 635 | $21K |
| D1206 | Topical application of fluoride varnish | 558 | 551 | $9K |
| D0120 | Periodic oral evaluation - established patient | 385 | 383 | $7K |
| D1120 | Prophylaxis - child | 158 | 156 | $4K |
| D0272 | Bitewings - two radiographic images | 44 | 44 | $1K |
| D0220 | Intraoral - periapical first radiographic image | 85 | 85 | $881.40 |
| D0330 | Panoramic radiographic image | 12 | 12 | $831.36 |
| D0274 | Bitewings - four radiographic images | 13 | 13 | $414.86 |