SPECIAL CARE DENTAL OF MISSOURI LLC
NPI: 1790127512
· LEAWOOD, KS 66211
· Dental Hygienist
· NPI assigned 07/22/2013
$747K
Total Medicaid Paid
Provider Details
| Authorized Official | SEPANEK, LESLIE (CREDENTIALING SPECIALIST) |
| NPI Enumeration Date | 07/22/2013 |
Related Entities
Other providers sharing the same authorized official: SEPANEK, LESLIE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
256 |
$7K |
| 2019 |
1,268 |
$30K |
| 2020 |
260 |
$8K |
| 2021 |
2,085 |
$45K |
| 2022 |
1,504 |
$57K |
| 2023 |
5,630 |
$275K |
| 2024 |
6,111 |
$326K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
3,053 |
2,625 |
$207K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,443 |
3,770 |
$202K |
| D9410 |
|
3,017 |
2,573 |
$152K |
| D1110 |
Prophylaxis - adult |
2,524 |
2,131 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
1,749 |
1,468 |
$48K |
| D1206 |
Topical application of fluoride varnish |
1,711 |
1,423 |
$0.00 |
| D1330 |
|
227 |
200 |
$0.00 |
| D1999 |
|
370 |
354 |
$0.00 |
| D9932 |
|
20 |
12 |
$0.00 |