PDC- LEHI UTAH
NPI: 1851722383
· LEHL, UT 84043
· General Practice Dentistry
· NPI assigned 12/10/2013
Provider Details
| Authorized Official | WARNER, JACOB (CREDENTIALING MANAGER) |
| NPI Enumeration Date | 12/10/2013 |
Related Entities
Other providers sharing the same authorized official: WARNER, JACOB
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
377 |
$12K |
| 2019 |
37 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
37 |
29 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
24 |
24 |
$3K |
| D1351 |
Sealant - per tooth |
89 |
12 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
30 |
13 |
$1K |
| D1120 |
Prophylaxis - child |
38 |
30 |
$513.98 |
| D1206 |
Topical application of fluoride varnish |
69 |
60 |
$232.65 |
| D0220 |
Intraoral - periapical first radiographic image |
53 |
52 |
$105.81 |
| D0230 |
Intraoral - periapical each additional radiographic image |
62 |
38 |
$0.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |