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GREAT RIVER ORTHODONTIC SPECIALISTS, SC
GREAT RIVER ORTHODONTIC SPECIALISTS, SC
NPI: 1891442174
· HUDSON, WI 54016
· Orthodontics and Dentofacial Orthopedic Dentist
· NPI assigned 03/07/2022
$409K
Total Medicaid Paid
Provider Details
| Authorized Official | AMIDON, LORI (PATIENT ACCOUNTS MGR) |
| NPI Enumeration Date | 03/07/2022 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
743 |
$97K |
| 2024 |
1,559 |
$312K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
1,636 |
1,634 |
$340K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
14 |
13 |
$22K |
| D0340 |
|
164 |
164 |
$17K |
| D0350 |
|
163 |
163 |
$13K |
| D0330 |
Panoramic radiographic image |
162 |
162 |
$11K |
| D8660 |
|
163 |
163 |
$6K |