GREATER SEACOAST COMMUNITY HEALTH

NPI: 1811150519 · PORTSMOUTH, NH 03801 · General Practice Dentistry · NPI assigned 07/03/2008

$30K

Total Medicaid Paid

1,423

Total Claims

1,022

Beneficiaries

Codes Billed

2018-01

First Month

2019-07

Last Month

Provider Details

Authorized Official	GARCA, KIMBERLY (BILLING MANAGER)
Parent Organization	GREATER SEACOAST COMMUNITY HEALTH
NPI Enumeration Date	07/03/2008

Other providers sharing the same authorized official: GARCA, KIMBERLY

Provider	City	State	Total Paid
GREATER SEACOAST COMMUNITY HEALTH	PORTSMOUTH	NH	$6.64M
GREATER SEACOAST COMMUNITY HEALTH	ROCHESTER	NH	$2.02M
GREATER SEACOAST COMMUNITY HEALTH	PORTSMOUTH	NH	$153K
GREATER SEACOAST COMMUNITY HEALTH	PORTSMOUTH	NH	$53K

Year	Claims	Total Paid
2018	1,365	$28K
2019	58	$1K

Code	Description	Claims	Beneficiaries	Total Paid
D0140	Limited oral evaluation - problem focused	278	200	$8K
D1120	Prophylaxis - child	230	167	$6K
D0120	Periodic oral evaluation - established patient	264	197	$6K
D1208	Topical application of fluoride, excluding varnish	362	271	$5K
D1110	Prophylaxis - adult	58	40	$2K
D7140	Extraction, erupted tooth or exposed root	29	12	$2K
D0220	Intraoral - periapical first radiographic image	152	93	$574.00
D0330	Panoramic radiographic image	21	13	$450.00
T1016	Case management, each 15 minutes	29	29	$0.00