AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC

NPI: 1790446508 · MEMPHIS, TN 38119 · General Practice Dentistry · NPI assigned 01/04/2022

$30K

Total Medicaid Paid

1,489

Total Claims

1,322

Beneficiaries

Codes Billed

2023-06

First Month

2024-02

Last Month

Provider Details

Authorized Official	HAYES, CELIA (CREDENTIALING COORDINATOR)
Parent Organization	AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
NPI Enumeration Date	01/04/2022

Other providers sharing the same authorized official: HAYES, CELIA

Provider	City	State	Total Paid
ST PAUL ORAL SURGERY AND DENTAL IMPLANTS LLC	SAINT PAUL	MN	$1.26M
FAMILY PEDIATRIC DENTAL SPECIALISTS PLC	BURNSVILLE	MN	$756K
FAMILY ORTHODONTIC SPECIALISTS, PLC	RICHFIELD	MN	$277K
TRU DENTAL MICHIGAN II, PLLC	LAPEER	MI	$169K
CAPITAL AREA HUDSON VALLEY NEW YORK DENTAL PC	GREENFIELD	MA	$17K
TRU DENTAL MICHIGAN II, PLLC	WARREN	MI	$17K
TRU DENTAL MICHIGAN PC	LIVONIA	MI	$16K
TRU DENTAL MICHIGAN PC	DEARBORN HEIGHTS	MI	$1K

Year	Claims	Total Paid
2023	1,251	$27K
2024	238	$3K

Code	Description	Claims	Beneficiaries	Total Paid
D1110	Prophylaxis - adult	195	182	$7K
D0120	Periodic oral evaluation - established patient	349	326	$7K
D1206	Topical application of fluoride varnish	369	346	$7K
D0274	Bitewings - four radiographic images	172	164	$4K
D0220	Intraoral - periapical first radiographic image	173	158	$2K
D0230	Intraoral - periapical each additional radiographic image	166	84	$1K
D0330	Panoramic radiographic image	31	31	$963.77
D4346		15	15	$627.38
D1120	Prophylaxis - child	19	16	$496.86