LAKE ODESSA DENTAL, PLLC
NPI: 1851889471
· LAKE ODESSA, MI 48849
· Dental Clinic/Center
· NPI assigned 04/30/2018
$715.00
Total Medicaid Paid
Provider Details
| Authorized Official | CRETE, MICHAEL (MEMBER) |
| NPI Enumeration Date | 04/30/2018 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
25 |
$715.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12 |
12 |
$440.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$275.00 |