NPI: 1740604222 · MIDLOTHIAN, VA 23112 · Dentist · NPI assigned 02/05/2014
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 115 | $3K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 23 | 23 | $770.96 |
| D1110 | Prophylaxis - adult | 15 | 15 | $707.85 |
| D1206 | Topical application of fluoride varnish | 34 | 34 | $706.86 |
| D0120 | Periodic oral evaluation - established patient | 31 | 31 | $624.65 |
| D0274 | Bitewings - four radiographic images | 12 | 12 | $331.20 |