IVORY DENTAL PC
NPI: 1770902090
· SOUTHBRIDGE, MA 01550
· General Practice Dentistry
· NPI assigned 04/15/2014
$140K
Total Medicaid Paid
Provider Details
Related Entities
Other providers sharing the same authorized official: DONTHI REDDY, SUSHMA REDDY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
425 |
$16K |
| 2019 |
1,049 |
$44K |
| 2020 |
509 |
$21K |
| 2021 |
509 |
$19K |
| 2022 |
509 |
$21K |
| 2023 |
346 |
$14K |
| 2024 |
128 |
$5K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
991 |
984 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,110 |
1,105 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
265 |
261 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
227 |
226 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
340 |
340 |
$10K |
| D1120 |
Prophylaxis - child |
186 |
186 |
$9K |
| D0274 |
Bitewings - four radiographic images |
121 |
121 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
111 |
107 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
101 |
98 |
$2K |