TRI-STATE DENTAL
NPI: 1821165580
· SIOUX CITY, IA 51104
· General Practice Dentistry
· NPI assigned 11/29/2006
$957.33
Total Medicaid Paid
Provider Details
| Authorized Official | REINKING, JEFF (OWNER) |
| NPI Enumeration Date | 11/29/2006 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
44 |
$773.67 |
| 2022 |
12 |
$183.66 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
42 |
38 |
$733.82 |
| D1206 |
Topical application of fluoride varnish |
14 |
12 |
$223.51 |