NPI: 1780029520 · JACKSON, OH 45640 · Dentist · NPI assigned 05/07/2013
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 31 | $1K |
| 2019 | 12 | $215.16 |
| 2020 | 143 | $3K |
| 2021 | 159 | $4K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 192 | 192 | $3K |
| D1110 | Prophylaxis - adult | 83 | 83 | $3K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 18 | 12 | $967.86 |
| D1206 | Topical application of fluoride varnish | 27 | 27 | $425.25 |
| D0274 | Bitewings - four radiographic images | 13 | 13 | $273.00 |
| D1120 | Prophylaxis - child | 12 | 12 | $252.00 |