NPI: 1720393770 · SAN BENITO, TX 78586 · Dentist · NPI assigned 08/15/2010
| Year | Claims | Total Paid |
|---|---|---|
| 2023 | 58 | $990.23 |
| 2024 | 593 | $11K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 112 | 112 | $3K |
| D1120 | Prophylaxis - child | 56 | 56 | $2K |
| D1206 | Topical application of fluoride varnish | 121 | 121 | $2K |
| D0274 | Bitewings - four radiographic images | 58 | 58 | $2K |
| D0220 | Intraoral - periapical first radiographic image | 110 | 110 | $1K |
| D0230 | Intraoral - periapical each additional radiographic image | 109 | 108 | $1K |
| D1110 | Prophylaxis - adult | 14 | 14 | $768.32 |
| D0602 | 59 | 59 | $0.00 | |
| D0601 | 12 | 12 | $0.00 |