NPI: 1841349891 · OZARK, MO 65721 · Pediatric Dentist · NPI assigned 01/09/2007
| Authorized Official | MILLSAP, JOE (PROGRAM DIRECTOR) |
| NPI Enumeration Date | 01/09/2007 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 105 | $1K |
| 2019 | 24 | $433.08 |
| 2020 | 69 | $1K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1206 | Topical application of fluoride varnish | 90 | 89 | $1K |
| D0120 | Periodic oral evaluation - established patient | 38 | 38 | $812.02 |
| D0274 | Bitewings - four radiographic images | 39 | 39 | $614.76 |
| D1120 | Prophylaxis - child | 18 | 17 | $302.50 |
| D0220 | Intraoral - periapical first radiographic image | 13 | 13 | $74.40 |