NPI: 1760895742 · SAN BENITO, TX 78586 · Dentist · NPI assigned 06/06/2014
| Year | Claims | Total Paid |
|---|---|---|
| 2023 | 100 | $3K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 12 | 12 | $658.56 |
| D0120 | Periodic oral evaluation - established patient | 22 | 22 | $634.70 |
| D1120 | Prophylaxis - child | 14 | 14 | $514.50 |
| D0274 | Bitewings - four radiographic images | 14 | 14 | $380.71 |
| D1208 | Topical application of fluoride, excluding varnish | 24 | 24 | $352.80 |
| D0603 | 14 | 14 | $0.00 |