NPI: 1770894701 · TOOELE, UT 84074 · Dentist · NPI assigned 06/24/2010
| Year | Claims | Total Paid |
|---|---|---|
| 2024 | 115 | $3K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0150 | Comprehensive oral evaluation - new or established patient | 29 | 29 | $1K |
| D0220 | Intraoral - periapical first radiographic image | 45 | 43 | $704.54 |
| D1120 | Prophylaxis - child | 13 | 13 | $558.72 |
| D0230 | Intraoral - periapical each additional radiographic image | 28 | 26 | $325.50 |