NATHAN SUTER DDS MOBILE LLC
NPI: 1780358622
· MARYLAND HEIGHTS, MO 63043
· Dental Clinic/Center
· NPI assigned 08/04/2021
$166K
Total Medicaid Paid
Provider Details
| Authorized Official | HUMPHREY, ADAM (AUTHORIZED AGENT) |
| NPI Enumeration Date | 08/04/2021 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
299 |
$14K |
| 2023 |
243 |
$14K |
| 2024 |
3,899 |
$138K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
614 |
553 |
$38K |
| D9410 |
|
894 |
794 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
624 |
543 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
424 |
358 |
$24K |
| D0274 |
Bitewings - four radiographic images |
343 |
300 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
446 |
388 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
130 |
124 |
$7K |
| D9996 |
|
438 |
399 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
14 |
12 |
$562.60 |
| D1206 |
Topical application of fluoride varnish |
52 |
52 |
$36.80 |
| D0350 |
|
261 |
237 |
$0.00 |
| D0191 |
|
81 |
78 |
$0.00 |
| D1310 |
|
42 |
42 |
$0.00 |
| D1330 |
|
78 |
76 |
$0.00 |