A GREAT SMILE DENTAL CENTER LLC
NPI: 1811188014
· WASHINGTON, DC 20012
· Dentist
· NPI assigned 08/05/2007
$138K
Total Medicaid Paid
3,668
Beneficiary Records
Provider Details
| Authorized Official | SHAW, MARLENE (DENTIST) |
| NPI Enumeration Date | 08/05/2007 |
Related Entities
Other providers sharing the same authorized official: SHAW, MARLENE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,550 |
$57K |
| 2019 |
715 |
$28K |
| 2020 |
476 |
$17K |
| 2021 |
914 |
$33K |
| 2022 |
108 |
$3K |
Billing Codes
| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
549 |
542 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
973 |
964 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,112 |
1,103 |
$27K |
| D0274 |
Bitewings - four radiographic images |
521 |
517 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
27 |
$7K |
| D1120 |
Prophylaxis - child |
134 |
134 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
348 |
312 |
$6K |
| D0330 |
Panoramic radiographic image |
45 |
45 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$763.53 |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
12 |
$257.07 |