SAMUEL L. KOTH, DDS, PC
NPI: 1760734263
· ROCK VALLEY, IA 51247
· General Practice Dentistry
· NPI assigned 10/08/2012
Provider Details
| Authorized Official | KOTH, SAMUEL (DENTIST/PRESIDENT) |
| NPI Enumeration Date | 10/08/2012 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
808 |
$19K |
| 2019 |
578 |
$13K |
| 2020 |
408 |
$9K |
| 2021 |
548 |
$13K |
| 2022 |
538 |
$14K |
| 2023 |
360 |
$10K |
| 2024 |
194 |
$5K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,350 |
1,292 |
$29K |
| D1110 |
Prophylaxis - adult |
513 |
500 |
$19K |
| D1120 |
Prophylaxis - child |
587 |
562 |
$18K |
| D1206 |
Topical application of fluoride varnish |
911 |
863 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
12 |
$838.72 |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$491.18 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$460.50 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$336.22 |