NPI: 1720174543 · MIDLAND, MI 48640 · Dentist · NPI assigned 10/05/2006
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 881 | $25K |
| 2019 | 935 | $29K |
| 2020 | 239 | $7K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 636 | 635 | $23K |
| D0120 | Periodic oral evaluation - established patient | 750 | 749 | $20K |
| D1206 | Topical application of fluoride varnish | 307 | 307 | $7K |
| D1208 | Topical application of fluoride, excluding varnish | 309 | 308 | $7K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 26 | 13 | $3K |
| D0274 | Bitewings - four radiographic images | 12 | 12 | $396.00 |
| D0272 | Bitewings - two radiographic images | 15 | 15 | $350.00 |