SMILE PREMIER A DENTAL HYGIENE PRACTICE OF ELIZABETH BRUTUS RDHAP COR
NPI: 1861094971
· SAN BERNARDINO, CA 92408
· Dental Clinic/Center
· NPI assigned 11/12/2020
$389K
Total Medicaid Paid
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
477 |
$16K |
| 2022 |
1,115 |
$53K |
| 2023 |
4,000 |
$148K |
| 2024 |
3,983 |
$171K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,104 |
2,076 |
$184K |
| D0210 |
Intraoral - complete series of radiographic images |
1,981 |
1,953 |
$94K |
| D1206 |
Topical application of fluoride varnish |
2,619 |
2,586 |
$47K |
| D1351 |
Sealant - per tooth |
802 |
215 |
$30K |
| D1120 |
Prophylaxis - child |
473 |
472 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,141 |
576 |
$5K |
| D0274 |
Bitewings - four radiographic images |
132 |
132 |
$3K |
| D0272 |
Bitewings - two radiographic images |
139 |
139 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
136 |
136 |
$2K |
| D9410 |
|
31 |
31 |
$868.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
17 |
$255.00 |