NPI: 1720074206 · ROCK FALLS, IL 61071 · Dentist · NPI assigned 09/21/2005
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 1,561 | $42K |
| 2019 | 554 | $14K |
| 2021 | 173 | $6K |
| 2022 | 24 | $3K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 613 | 595 | $24K |
| D1120 | Prophylaxis - child | 597 | 586 | $18K |
| D1206 | Topical application of fluoride varnish | 574 | 565 | $12K |
| D1351 | Sealant - per tooth | 168 | 76 | $7K |
| D0220 | Intraoral - periapical first radiographic image | 67 | 56 | $2K |
| D0330 | Panoramic radiographic image | 12 | 12 | $213.70 |
| D0601 | 196 | 196 | $0.00 | |
| D0602 | 85 | 85 | $0.00 |