NPI: 1790030542 · COOPERSTOWN, NY 13326 · Dentist · NPI assigned 07/18/2012
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 291 | $7K |
| 2019 | 149 | $819.00 |
| 2020 | 143 | $0.00 |
| 2024 | 56 | $1K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 64 | 64 | $3K |
| D1110 | Prophylaxis - adult | 29 | 29 | $2K |
| D0120 | Periodic oral evaluation - established patient | 39 | 39 | $1K |
| D1206 | Topical application of fluoride varnish | 56 | 56 | $1K |
| D1208 | Topical application of fluoride, excluding varnish | 56 | 56 | $969.75 |
| D0274 | Bitewings - four radiographic images | 13 | 13 | $564.96 |
| D0272 | Bitewings - two radiographic images | 14 | 14 | $358.15 |
| D9995 | 35 | 35 | $0.00 | |
| D1330 | 172 | 150 | $0.00 | |
| D1310 | 17 | 17 | $0.00 | |
| D0191 | 144 | 126 | $0.00 |