GAMBLE DENTALSMART PC

NPI: 1851752810 · ORANGEBURG, SC 29115 · General Practice Dentistry · NPI assigned 03/17/2016

$18K

Total Medicaid Paid

650

Total Claims

639

Beneficiaries

Codes Billed

2018-01

First Month

2018-08

Last Month

Provider Details

Authorized Official	GAMBLE, ROBERT (DENTIST OWNER)
NPI Enumeration Date	03/17/2016

Other providers sharing the same authorized official: GAMBLE, ROBERT

Provider	City	State	Total Paid
INCORPORATION TO MAXIMIZE PERSONAL ACHIEVEMENT WITH COMMUNITY TRAINING	PORT HURON	MI	$600K
GAMBLE DENTALSMART PC	MANNING	SC	$63K
GAMBLE DENTALSMART PC	SUMTER	SC	$47K
GAMBLE DENTALSMART PC	MURRELLS INLET	SC	$21K
GAMBLE DENTALSMART PC	COLUMBIA	SC	$3K

Year	Claims	Total Paid
2018	650	$18K

Code	Description	Claims	Beneficiaries	Total Paid
D1110	Prophylaxis - adult	82	82	$4K
D0150	Comprehensive oral evaluation - new or established patient	98	98	$4K
D0140	Limited oral evaluation - problem focused	80	80	$3K
D0274	Bitewings - four radiographic images	96	96	$2K
D0330	Panoramic radiographic image	47	47	$2K
D0220	Intraoral - periapical first radiographic image	157	151	$2K
D0230	Intraoral - periapical each additional radiographic image	66	61	$576.47
D1206	Topical application of fluoride varnish	24	24	$388.80