ATLANTIC DENTAL
NPI: 1770755514
· LYNN, MA 01902
· Dentist
· NPI assigned 04/01/2008
$856.00
Total Medicaid Paid
Provider Details
| Authorized Official | VASSERMAN, ILYA (PRESIDENT) |
| NPI Enumeration Date | 04/01/2008 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
25 |
$856.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
12 |
12 |
$560.00 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$296.00 |