GUSTAVO SALAS DDS MS PLLC
NPI: 1720543580
· KATY, TX 77449
· Orthodontics and Dentofacial Orthopedic Dentist
· NPI assigned 02/06/2019
$230K
Total Medicaid Paid
Provider Details
| Authorized Official | SALAS, GUSTAVO (OWNER) |
| NPI Enumeration Date | 02/06/2019 |
Related Entities
Other providers sharing the same authorized official: SALAS, GUSTAVO
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
420 |
$8K |
| 2021 |
4,758 |
$90K |
| 2022 |
3,478 |
$64K |
| 2023 |
2,509 |
$49K |
| 2024 |
930 |
$19K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,702 |
1,670 |
$46K |
| D1120 |
Prophylaxis - child |
1,010 |
995 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,095 |
1,068 |
$33K |
| D1110 |
Prophylaxis - adult |
553 |
542 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,825 |
1,795 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,864 |
1,824 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,843 |
1,788 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
66 |
66 |
$9K |
| D1351 |
Sealant - per tooth |
279 |
40 |
$7K |
| D0272 |
Bitewings - two radiographic images |
220 |
218 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$413.25 |
| D0602 |
|
169 |
168 |
$0.00 |
| D0601 |
|
671 |
659 |
$0.00 |
| D0603 |
|
758 |
742 |
$0.00 |
| D9986 |
|
28 |
28 |
$0.00 |