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CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANS
CONFEDERATED TRIBES OF COOS, LOWER UMPQUA & SIUSLAW INDIANS
NPI: 1780755454
· COOS BAY, OR 97420
· Cardiovascular Disease Physician
· NPI assigned 11/13/2006
$594K
Total Medicaid Paid
Provider Details
| Authorized Official | SMITH, DAVON (CHIEF OPERATIONS OFFICER) |
| NPI Enumeration Date | 11/13/2006 |
Related Entities
Other providers sharing the same authorized official: SMITH, DAVON
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
870 |
$123K |
| 2019 |
1,012 |
$127K |
| 2020 |
264 |
$31K |
| 2021 |
801 |
$87K |
| 2022 |
586 |
$31K |
| 2023 |
747 |
$48K |
| 2024 |
1,231 |
$146K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
713 |
699 |
$287K |
| D1110 |
Prophylaxis - adult |
358 |
348 |
$118K |
| D0140 |
Limited oral evaluation - problem focused |
112 |
109 |
$56K |
| D1120 |
Prophylaxis - child |
206 |
201 |
$54K |
| D1355 |
|
264 |
212 |
$22K |
| D1354 |
|
199 |
46 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
24 |
$16K |
| D1351 |
Sealant - per tooth |
358 |
55 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
693 |
661 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
206 |
196 |
$0.00 |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
499 |
178 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,804 |
1,680 |
$0.00 |
| D1330 |
|
31 |
31 |
$0.00 |