NPI: 1790820587 · POTOSI, MO 63664 · Dentist · NPI assigned 02/20/2007
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 806 | $18K |
| 2019 | 287 | $3K |
| 2020 | 12 | $180.00 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 202 | 198 | $5K |
| D0120 | Periodic oral evaluation - established patient | 254 | 253 | $5K |
| D1206 | Topical application of fluoride varnish | 333 | 330 | $4K |
| D0330 | Panoramic radiographic image | 80 | 78 | $3K |
| D0272 | Bitewings - two radiographic images | 160 | 160 | $2K |
| D0150 | Comprehensive oral evaluation - new or established patient | 38 | 38 | $1K |
| D1120 | Prophylaxis - child | 38 | 38 | $836.00 |