HENYRETTA DENTAL CENTER 2, PLLC
NPI: 1750660700
· HENRYETTA, OK 74437
· Dental Clinic/Center
· NPI assigned 08/09/2011
$116K
Total Medicaid Paid
Provider Details
| Authorized Official | JOHNSON, JEREMY (DENTIST) |
| NPI Enumeration Date | 08/09/2011 |
Related Entities
Other providers sharing the same authorized official: JOHNSON, JEREMY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,096 |
$22K |
| 2019 |
1,018 |
$21K |
| 2020 |
943 |
$22K |
| 2021 |
996 |
$22K |
| 2022 |
820 |
$19K |
| 2023 |
445 |
$10K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,707 |
1,707 |
$35K |
| D1120 |
Prophylaxis - child |
1,075 |
1,075 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,903 |
1,903 |
$28K |
| D1110 |
Prophylaxis - adult |
382 |
382 |
$17K |
| D0272 |
Bitewings - two radiographic images |
197 |
197 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$1K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$348.60 |
| 98940 |
|
23 |
14 |
$299.00 |