MARK S. OLIVERSON, D.M.D.
NPI: 1801058862
· SALMON, ID 83467
· Dental Clinic/Center
· NPI assigned 06/30/2008
$780.16
Total Medicaid Paid
Provider Details
| Authorized Official | OLIVERSON, MARK (GENERAL DENTIST) |
| NPI Enumeration Date | 06/30/2008 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
16 |
$0.00 |
| 2022 |
44 |
$780.16 |
| 2023 |
28 |
$0.00 |
| 2024 |
26 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
16 |
16 |
$780.16 |
| D0120 |
Periodic oral evaluation - established patient |
98 |
98 |
$0.00 |