SOMERVILLE PEDIATRIC DENTISTRY AND ORTHODONTICS
NPI: 1790254845
· SOMERVILLE, MA 02145
· Pediatric Dentist
· NPI assigned 11/19/2018
$155K
Total Medicaid Paid
Provider Details
| Authorized Official | LEE, MOONYOUNG (PRESIDENT) |
| NPI Enumeration Date | 11/19/2018 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
51 |
$2K |
| 2021 |
423 |
$28K |
| 2022 |
81 |
$22K |
| 2023 |
173 |
$40K |
| 2024 |
233 |
$63K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
494 |
483 |
$135K |
| D1120 |
Prophylaxis - child |
169 |
168 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
174 |
173 |
$5K |
| D9310 |
|
41 |
41 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
36 |
36 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
30 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
17 |
17 |
$470.00 |