LAKE SUPERIOR DENTAL ASSOCIATES
NPI: 1871672584
· DULUTH, MN 55805
· General Practice Dentistry
· NPI assigned 11/03/2006
$122K
Total Medicaid Paid
Provider Details
| Authorized Official | RYAN, ROBERT (PARTNER) |
| NPI Enumeration Date | 11/03/2006 |
Related Entities
Other providers sharing the same authorized official: RYAN, ROBERT
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
259 |
$1K |
| 2019 |
496 |
$14K |
| 2020 |
523 |
$13K |
| 2021 |
1,418 |
$34K |
| 2022 |
902 |
$33K |
| 2023 |
454 |
$15K |
| 2024 |
356 |
$12K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,364 |
1,357 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,610 |
1,598 |
$35K |
| D1206 |
Topical application of fluoride varnish |
905 |
897 |
$17K |
| D0274 |
Bitewings - four radiographic images |
386 |
384 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
39 |
$1K |
| D1120 |
Prophylaxis - child |
31 |
31 |
$801.67 |
| D0220 |
Intraoral - periapical first radiographic image |
44 |
42 |
$472.85 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
14 |
$175.05 |
| D9985 |
|
14 |
12 |
$0.00 |