SAMANTHA JETTE DDS - PROFESSIONAL CORPORATION
NPI: 1881288058
· BRIDGEPORT, WV 26330
· Dental Clinic/Center
· NPI assigned 02/27/2021
Provider Details
| Authorized Official | JETTE, SAMANTHA (PRESIDENT) |
| NPI Enumeration Date | 02/27/2021 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2024 |
215 |
$7K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
47 |
42 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
83 |
82 |
$2K |
| D1206 |
Topical application of fluoride varnish |
56 |
56 |
$1K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$488.40 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
12 |
$462.00 |