NPI: 1740343086 · SHAWANO, WI 54166 · Dentist · NPI assigned 12/18/2006
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 919 | $17K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 257 | 236 | $6K |
| D1208 | Topical application of fluoride, excluding varnish | 292 | 270 | $4K |
| D0120 | Periodic oral evaluation - established patient | 255 | 252 | $4K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 25 | 13 | $2K |
| D0272 | Bitewings - two radiographic images | 78 | 75 | $1K |
| D0330 | Panoramic radiographic image | 12 | 12 | $364.05 |