NPI: 1831504125 · AMMON, ID 83406 · Pediatric Dentist · NPI assigned 06/25/2014
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 510 | $13K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1120 | Prophylaxis - child | 132 | 132 | $4K |
| D0120 | Periodic oral evaluation - established patient | 148 | 147 | $3K |
| D1208 | Topical application of fluoride, excluding varnish | 153 | 152 | $3K |
| D1110 | Prophylaxis - adult | 16 | 16 | $684.00 |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 14 | 12 | $638.00 |
| D0272 | Bitewings - two radiographic images | 35 | 35 | $632.00 |
| D0274 | Bitewings - four radiographic images | 12 | 12 | $406.00 |