RANDOLPH T. EVANS, D.D.S. P.L.L.C.
NPI: 1902026479
· MARTINSBURG, WV 25403
· General Practice Dentistry
· NPI assigned 04/26/2007
$765.00
Total Medicaid Paid
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
48 |
$765.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
17 |
17 |
$425.00 |
| D1206 |
Topical application of fluoride varnish |
17 |
17 |
$340.00 |
| D9630 |
|
14 |
14 |
$0.00 |