NPI: 1801520796 · WILMINGTON, VT 05363 · Dental Clinic/Center · NPI assigned 07/15/2022
| Authorized Official | SRECA, TIFFANY (OWNER) |
| NPI Enumeration Date | 07/15/2022 |
| Year | Claims | Total Paid |
|---|---|---|
| 2022 | 784 | $20K |
| 2023 | 1,395 | $44K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 675 | 651 | $17K |
| D1110 | Prophylaxis - adult | 275 | 267 | $13K |
| D1206 | Topical application of fluoride varnish | 685 | 651 | $13K |
| D4346 | 127 | 121 | $9K | |
| D0274 | Bitewings - four radiographic images | 257 | 250 | $8K |
| D1120 | Prophylaxis - child | 89 | 89 | $3K |
| D4910 | 16 | 16 | $1K | |
| D1351 | Sealant - per tooth | 43 | 12 | $855.50 |
| D0330 | Panoramic radiographic image | 12 | 12 | $720.00 |