GUDMESTAD, TOM
NPI: 1851308050
· WEISER, ID 83672
· General Practice Dentistry
· NPI assigned 08/01/2006
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
141 |
$3K |
| 2019 |
28 |
$984.58 |
| 2020 |
93 |
$2K |
| 2021 |
43 |
$1K |
| 2022 |
26 |
$2K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
144 |
144 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
130 |
130 |
$19.24 |
| D1208 |
Topical application of fluoride, excluding varnish |
57 |
57 |
$0.00 |