FAMILY & COSMETIC GENTLE DENTISTRY, LTD
NPI: 1750563227
· PLYMOUTH, MN 55441
· General Practice Dentistry
· NPI assigned 11/27/2007
$171K
Total Medicaid Paid
Provider Details
| Authorized Official | GAVIC, DIANA (OPERATIONS MANAGER) |
| Parent Organization | FAMILY & COSMETIC GENTLE DENTISTRY, LTD |
| NPI Enumeration Date | 11/27/2007 |
Related Entities
Other providers sharing the same authorized official: GAVIC, DIANA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
492 |
$0.00 |
| 2019 |
80 |
$2K |
| 2020 |
132 |
$3K |
| 2021 |
403 |
$10K |
| 2022 |
955 |
$36K |
| 2023 |
1,391 |
$52K |
| 2024 |
1,660 |
$67K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
994 |
991 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,138 |
1,137 |
$32K |
| D0274 |
Bitewings - four radiographic images |
548 |
546 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
408 |
401 |
$19K |
| D1206 |
Topical application of fluoride varnish |
758 |
756 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
537 |
516 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
162 |
162 |
$7K |
| D0330 |
Panoramic radiographic image |
58 |
58 |
$5K |
| D1120 |
Prophylaxis - child |
101 |
99 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
293 |
84 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
13 |
$3K |
| D1330 |
|
34 |
34 |
$2K |
| D0460 |
|
44 |
44 |
$1K |