ELIZABETH AVENUE DENTISTRY, PC
NPI: 1851781561
· ELIZABETH, NJ 07206
· Dental Clinic/Center
· NPI assigned 02/02/2015
$109K
Total Medicaid Paid
Provider Details
Related Entities
Other providers sharing the same authorized official: KHAYLOMSKY, LENA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
119 |
$9K |
| 2021 |
172 |
$3K |
| 2022 |
395 |
$8K |
| 2023 |
1,177 |
$53K |
| 2024 |
1,170 |
$36K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
145 |
93 |
$56K |
| D1110 |
Prophylaxis - adult |
925 |
916 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
636 |
630 |
$13K |
| D0330 |
Panoramic radiographic image |
271 |
268 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
273 |
270 |
$6K |
| D2954 |
|
54 |
41 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
596 |
473 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
101 |
101 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
32 |
$960.00 |