WELLENSIEK, TODD
NPI: 1780673350
· TECUMSEH, NE 68450
· General Practice Dentistry
· NPI assigned 10/17/2005
$504.00
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
24 |
$504.00 |
Billing Codes
| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$264.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$240.00 |