NPI: 1831632173 · FORT WORTH, TX 76102 · General Practice Dentistry · NPI assigned 11/18/2016
Authorized official KOUYOUMDJIAN, RAFFY controls 19+ related entities in our dataset. Read more
| Authorized Official | KOUYOUMDJIAN, RAFFY (OWNER) |
| NPI Enumeration Date | 11/18/2016 |
Other providers sharing the same authorized official: KOUYOUMDJIAN, RAFFY
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 14 | $0.00 |
| 2019 | 162 | $1K |
| 2020 | 6,166 | $185K |
| 2021 | 47,500 | $1.48M |
| 2022 | 53,363 | $1.81M |
| 2023 | 59,418 | $2.00M |
| 2024 | 55,499 | $1.92M |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 7,135 | 1,471 | $1.04M |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 9,827 | 4,546 | $948K |
| D0145 | Oral evaluation for a patient under three years of age | 4,785 | 4,700 | $660K |
| D0120 | Periodic oral evaluation - established patient | 18,970 | 18,667 | $531K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 6,863 | 3,691 | $512K |
| D1120 | Prophylaxis - child | 13,358 | 13,191 | $477K |
| D1351 | Sealant - per tooth | 14,564 | 4,162 | $383K |
| D1110 | Prophylaxis - adult | 6,596 | 6,483 | $349K |
| D0230 | Intraoral - periapical each additional radiographic image | 32,344 | 19,538 | $326K |
| D7240 | Removal of impacted tooth - completely bony | 1,124 | 365 | $316K |
| D1208 | Topical application of fluoride, excluding varnish | 20,480 | 20,157 | $292K |
| D9248 | 1,991 | 1,963 | $233K | |
| D0274 | Bitewings - four radiographic images | 7,452 | 7,333 | $233K |
| D0220 | Intraoral - periapical first radiographic image | 20,838 | 20,442 | $222K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 7,017 | 6,671 | $182K |
| D0272 | Bitewings - two radiographic images | 7,673 | 7,580 | $158K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 959 | 637 | $99K |
| D0210 | Intraoral - complete series of radiographic images | 1,500 | 1,495 | $95K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 1,130 | 406 | $93K |
| D0330 | Panoramic radiographic image | 2,796 | 2,764 | $65K |
| D0150 | Comprehensive oral evaluation - new or established patient | 1,636 | 1,599 | $54K |
| D0160 | 2,987 | 2,884 | $43K | |
| D2934 | 246 | 85 | $35K | |
| D1330 | 2,163 | 2,130 | $23K | |
| D0140 | Limited oral evaluation - problem focused | 696 | 677 | $11K |
| D9223 | Deep sedation/general anesthesia - each subsequent 15 minute increment | 212 | 94 | $10K |
| D9222 | 105 | 97 | $7K | |
| D0350 | 223 | 223 | $3K | |
| D7140 | Extraction, erupted tooth or exposed root | 43 | 28 | $3K |
| D9612 | 81 | 70 | $2K | |
| D2330 | 22 | 13 | $2K | |
| D9310 | 13 | 13 | $174.96 | |
| D7111 | 15 | 12 | $160.58 | |
| D0270 | 12 | 12 | $53.90 | |
| D0603 | 26,266 | 25,800 | $0.08 |