GOMEZ, MARIANNA
NPI: 1851040067
· ONTARIO, CA 91764
· General Practice Dentistry
· NPI assigned 03/23/2022
$978.30
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
62 |
$978.30 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15 |
12 |
$441.00 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
12 |
$346.20 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
13 |
$191.10 |
| D0603 |
|
16 |
13 |
$0.00 |