GEORGE JEDLICKA DMD, PC
NPI: 1760741177
· SOLDOTNA, AK 99669
· General Practice Dentistry
· NPI assigned 05/07/2012
$113K
Total Medicaid Paid
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,061 |
$50K |
| 2019 |
515 |
$26K |
| 2020 |
258 |
$14K |
| 2021 |
374 |
$23K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
680 |
550 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
617 |
549 |
$26K |
| D0274 |
Bitewings - four radiographic images |
390 |
327 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
336 |
313 |
$9K |
| D1120 |
Prophylaxis - child |
116 |
105 |
$7K |
| D0330 |
Panoramic radiographic image |
38 |
34 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
14 |
$317.59 |