SUMMIT COMMUNITY CARE CLINIC, INC.
NPI: 1821450008
· LEADVILLE, CO 80461
· Dental Clinic/Center
· NPI assigned 03/25/2016
$1.01M
Total Medicaid Paid
Provider Details
| Authorized Official | BECKER, DANIEL (CEO) |
| NPI Enumeration Date | 03/25/2016 |
Related Entities
Other providers sharing the same authorized official: BECKER, DANIEL
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
13 |
$4K |
| 2019 |
321 |
$92K |
| 2020 |
503 |
$140K |
| 2021 |
957 |
$268K |
| 2022 |
973 |
$224K |
| 2023 |
966 |
$214K |
| 2024 |
186 |
$69K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
3,320 |
2,905 |
$1.01M |
| D0120 |
Periodic oral evaluation - established patient |
360 |
351 |
$770.00 |
| D0274 |
Bitewings - four radiographic images |
44 |
40 |
$360.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
25 |
$280.00 |
| D1206 |
Topical application of fluoride varnish |
59 |
59 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
95 |
95 |
$0.00 |