MARYLAND FAMILY AND GENERAL DENTISTRY, L.L.C

NPI: 1881391704 · GERMANTOWN, MD 20874 · General Practice Dentistry · NPI assigned 02/10/2023

$31K

Total Medicaid Paid

647

Total Claims

640

Beneficiaries

Codes Billed

2023-03

First Month

2024-10

Last Month

Provider Details

Authorized Official	GOORAH, SOORITA (OWNER AND EMPLOYEE)
NPI Enumeration Date	02/10/2023

Other providers sharing the same authorized official: GOORAH, SOORITA

Provider	City	State	Total Paid
MARYLAND DENTAL SPECIALTY GROUP	SILVER SPRING	MD	$843K
ASPEN HILL GENERAL& COSMETIC DENTISTRY	SILVER SPRING	MD	$618K

Year	Claims	Total Paid
2023	530	$25K
2024	117	$6K

Code	Description	Claims	Beneficiaries	Total Paid
D1110	Prophylaxis - adult	146	144	$9K
D0210	Intraoral - complete series of radiographic images	160	159	$9K
D0150	Comprehensive oral evaluation - new or established patient	148	146	$8K
D1206	Topical application of fluoride varnish	141	139	$4K
D0274	Bitewings - four radiographic images	12	12	$288.84
D0220	Intraoral - periapical first radiographic image	27	27	$265.95
D0230	Intraoral - periapical each additional radiographic image	13	13	$104.96