KOULIS, ANTONIA
NPI: 1801968532
· GLENVIEW, IL 60025
· General Practice Dentistry
· NPI assigned 11/15/2006
$413K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
9,724 |
$213K |
| 2019 |
9,640 |
$200K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,566 |
4,469 |
$120K |
| D1120 |
Prophylaxis - child |
3,538 |
3,448 |
$114K |
| D1351 |
Sealant - per tooth |
3,371 |
1,683 |
$109K |
| D1206 |
Topical application of fluoride varnish |
3,642 |
3,550 |
$69K |
| D0601 |
|
2,811 |
2,762 |
$0.00 |
| D0602 |
|
1,250 |
1,227 |
$0.00 |
| D0603 |
|
186 |
182 |
$0.00 |