FONTES, FERNANDA
NPI: 1740300904
· CHANTILLY, VA 20151
· Pediatric Dentist
· NPI assigned 03/30/2007
$975.40
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
40 |
$975.40 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12 |
12 |
$402.24 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$291.06 |
| D0120 |
Periodic oral evaluation - established patient |
14 |
14 |
$282.10 |