NPI: 1811288269 · LAKE ELMO, MN 55042 · Dental Clinic/Center · NPI assigned 04/20/2011
| Authorized Official | CERMAK, PENNY (CFO) |
| NPI Enumeration Date | 04/20/2011 |
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 89 | $13K |
| 2022 | 12 | $2K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 99204 | Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity | 72 | 72 | $9K |
| D7880 | 14 | 14 | $5K | |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 15 | 15 | $652.20 |