SAN JUAN PEDIATRIC DENTAL HOME PSC
NPI: 1780876995
· SAN JUAN, PR 00927
· Dental Clinic/Center
· NPI assigned 08/11/2007
$180K
Total Medicaid Paid
Provider Details
| Authorized Official | AYMAT, NOEL (PRESIDENT AND PEDIATRIC DENTIST) |
| NPI Enumeration Date | 08/11/2007 |
Related Entities
Other providers sharing the same authorized official: AYMAT, NOEL
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
2,166 |
$29K |
| 2019 |
2,291 |
$35K |
| 2020 |
1,904 |
$37K |
| 2021 |
1,780 |
$28K |
| 2022 |
1,694 |
$27K |
| 2023 |
625 |
$9K |
| 2024 |
946 |
$15K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
2,898 |
2,419 |
$39K |
| D1120 |
Prophylaxis - child |
2,091 |
1,787 |
$36K |
| D1999 |
|
2,000 |
1,790 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
2,063 |
1,777 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
702 |
245 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
619 |
511 |
$11K |
| D0272 |
Bitewings - two radiographic images |
774 |
688 |
$10K |
| D1110 |
Prophylaxis - adult |
259 |
209 |
$6K |