MILLE LACS BAND OF OJIBWE INDIANS
NPI: 1902941727
· ONAMIA, MN 56359
· General Practice Dentistry
· NPI assigned 02/20/2007
$1.87
Total Medicaid Paid
Provider Details
| Authorized Official | ANDERSON, NICOLE (COMMISSIONER OF HEALTH & HUMAN SERV) |
| Parent Organization | MILLE LACS BAND OF OJIBWE INDIANS |
| NPI Enumeration Date | 02/20/2007 |
Related Entities
Other providers sharing the same authorized official: ANDERSON, NICOLE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
| 2018 |
248 |
$0.00 |
| 2019 |
81 |
$0.00 |
| 2020 |
34 |
$1.87 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
| D0140 |
Limited oral evaluation - problem focused |
122 |
116 |
$1.35 |
| D0220 |
Intraoral - periapical first radiographic image |
133 |
124 |
$0.52 |
| D1120 |
Prophylaxis - child |
25 |
25 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
44 |
44 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$0.00 |