STATE OF DELAWARE
NPI: 1851463616
· DOVER, DE 19901
· Dental Clinic/Center
· NPI assigned 11/15/2006
$313K
Total Medicaid Paid
Provider Details
| Authorized Official | MCCLURE, GREGORY (DENTAL DIRECTOR) |
| NPI Enumeration Date | 11/15/2006 |
Related Entities
Other providers sharing the same authorized official: MCCLURE, GREGORY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
3,886 |
$154K |
| 2019 |
3,792 |
$152K |
| 2020 |
203 |
$8K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,100 |
1,095 |
$61K |
| D1351 |
Sealant - per tooth |
1,171 |
253 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
715 |
713 |
$51K |
| D1206 |
Topical application of fluoride varnish |
1,281 |
1,277 |
$44K |
| D0274 |
Bitewings - four radiographic images |
457 |
456 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
574 |
572 |
$24K |
| D1110 |
Prophylaxis - adult |
242 |
242 |
$18K |
| D0272 |
Bitewings - two radiographic images |
471 |
469 |
$18K |
| D0240 |
|
282 |
137 |
$7K |
| D0330 |
Panoramic radiographic image |
63 |
63 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
114 |
113 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
47 |
47 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
12 |
$291.07 |
| D0602 |
|
345 |
344 |
$0.00 |
| D0603 |
|
1,006 |
1,001 |
$0.00 |