WOODDALE DENTAL CENTER, LLC
NPI: 1881972560
· ST LOUIS PARK, MN 55416
· Dental Clinic/Center
· NPI assigned 07/28/2011
Provider Details
| Authorized Official | SIMIC, JELENA (DENTIST) |
| NPI Enumeration Date | 07/28/2011 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
112 |
$79.44 |
| 2019 |
174 |
$3K |
| 2020 |
24 |
$251.04 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
155 |
152 |
$2K |
| D1206 |
Topical application of fluoride varnish |
84 |
82 |
$1K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$282.72 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$0.00 |
| D1999 |
|
12 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
20 |
20 |
$0.00 |
| D1330 |
|
13 |
13 |
$0.00 |