NPI: 1750039327 · WAITE PARK, MN 56387 · Dental Clinic/Center · NPI assigned 03/14/2022
| Authorized Official | PETERSON, KARI (OWNER) |
| NPI Enumeration Date | 03/14/2022 |
| Year | Claims | Total Paid |
|---|---|---|
| 2022 | 107 | $2K |
| 2023 | 316 | $9K |
| 2024 | 240 | $8K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 362 | 356 | $9K |
| D1110 | Prophylaxis - adult | 121 | 118 | $6K |
| D1206 | Topical application of fluoride varnish | 138 | 137 | $2K |
| D1330 | 15 | 15 | $494.52 | |
| D1120 | Prophylaxis - child | 14 | 14 | $467.08 |
| D0274 | Bitewings - four radiographic images | 13 | 13 | $245.76 |