CLINICA DENTAL JIREH
NPI: 1881984854
· TOA BAJA, PR 00949
· General Practice Dentistry
· NPI assigned 04/12/2011
$114K
Total Medicaid Paid
Provider Details
| Authorized Official | BERRIOS, JOSE (ADMINISTRATOR) |
| NPI Enumeration Date | 04/12/2011 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
50 |
$948.00 |
| 2019 |
1,588 |
$34K |
| 2020 |
965 |
$20K |
| 2021 |
706 |
$13K |
| 2022 |
693 |
$15K |
| 2023 |
597 |
$14K |
| 2024 |
730 |
$17K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,278 |
975 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
887 |
609 |
$17K |
| D1999 |
|
750 |
659 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
306 |
174 |
$12K |
| D0272 |
Bitewings - two radiographic images |
668 |
541 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
621 |
438 |
$9K |
| D0330 |
Panoramic radiographic image |
247 |
199 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
493 |
376 |
$8K |
| D1120 |
Prophylaxis - child |
79 |
56 |
$1K |