PALMETTO FAMILY DENTISTRY OF ANDERSON, LLC
NPI: 1811377120
· ANDERSON, SC 29621
· Dentist
· NPI assigned 06/02/2015
$500K
Total Medicaid Paid
Provider Details
| Authorized Official | MITCHELL, JASON (PRESIDENT) |
| NPI Enumeration Date | 06/02/2015 |
Related Entities
Other providers sharing the same authorized official: MITCHELL, JASON
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
2,409 |
$66K |
| 2019 |
2,145 |
$64K |
| 2020 |
2,123 |
$61K |
| 2021 |
2,966 |
$104K |
| 2022 |
2,410 |
$78K |
| 2023 |
2,227 |
$66K |
| 2024 |
1,822 |
$60K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,537 |
3,537 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
5,167 |
5,167 |
$119K |
| D1206 |
Topical application of fluoride varnish |
3,989 |
3,989 |
$65K |
| D1120 |
Prophylaxis - child |
1,093 |
1,093 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
357 |
233 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,224 |
1,224 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
215 |
160 |
$18K |
| D0272 |
Bitewings - two radiographic images |
412 |
412 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
96 |
96 |
$4K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$601.08 |