CHARLES DREW HEALTH CENTER
NPI: 1871962944
· OMAHA, NE 68111
· Dental Clinic/Center
· NPI assigned 09/18/2015
$216K
Total Medicaid Paid
Provider Details
| Authorized Official | JACKSON, TARSHA (CHIEF FINANCIAL OFFICER) |
| Parent Organization | CHARLES DREW HEALTH CENTER |
| NPI Enumeration Date | 09/18/2015 |
Related Entities
Other providers sharing the same authorized official: JACKSON, TARSHA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2024 |
2,154 |
$216K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
702 |
667 |
$215K |
| D1120 |
Prophylaxis - child |
159 |
159 |
$457.19 |
| D1206 |
Topical application of fluoride varnish |
282 |
282 |
$351.75 |
| D0120 |
Periodic oral evaluation - established patient |
130 |
130 |
$112.46 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$89.31 |
| D0220 |
Intraoral - periapical first radiographic image |
204 |
204 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
46 |
46 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
592 |
147 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$0.00 |