NPI: 1750637732 · SOUTHGATE, MI 48195 · Dentist · NPI assigned 07/27/2012
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 443 | $11K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 77 | 77 | $3K |
| D0120 | Periodic oral evaluation - established patient | 101 | 100 | $3K |
| D1208 | Topical application of fluoride, excluding varnish | 99 | 99 | $2K |
| D0220 | Intraoral - periapical first radiographic image | 77 | 77 | $1K |
| D1110 | Prophylaxis - adult | 13 | 13 | $679.00 |
| D0230 | Intraoral - periapical each additional radiographic image | 76 | 76 | $651.00 |