G2 DENTAL
NPI: 1790776144
· FOREST LAKE, MN 55025
· Dentist
· NPI assigned 11/03/2005
$620.75
Total Medicaid Paid
Provider Details
| Authorized Official | KOCH, TRACEY (OFFICE MANAGER) |
| NPI Enumeration Date | 11/03/2005 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
13 |
$252.03 |
| 2020 |
36 |
$368.72 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
25 |
25 |
$459.45 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$91.10 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$70.20 |