CROSS TRAILS MEDICAL CENTER
NPI: 1841508264
· ADVANCE, MO 63730
· General Practice Dentistry
· NPI assigned 09/20/2010
$302K
Total Medicaid Paid
Provider Details
| Authorized Official | WELLS, MONA (CFO) |
| NPI Enumeration Date | 09/20/2010 |
Related Entities
Other providers sharing the same authorized official: WELLS, MONA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,067 |
$51K |
| 2019 |
1,329 |
$67K |
| 2020 |
1,616 |
$59K |
| 2021 |
1,374 |
$57K |
| 2022 |
438 |
$26K |
| 2023 |
390 |
$21K |
| 2024 |
467 |
$22K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,041 |
970 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,125 |
1,036 |
$54K |
| D0330 |
Panoramic radiographic image |
719 |
676 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
315 |
134 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,559 |
1,429 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
947 |
510 |
$19K |
| D0274 |
Bitewings - four radiographic images |
387 |
382 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
289 |
270 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
268 |
243 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
25 |
$3K |