IDAHO STATE UNIVERSITY
NPI: 1912110164
· BOISE, ID 83716
· Dentist
· NPI assigned 05/07/2007
Provider Details
| Authorized Official | FREEMAN, TINA (OFFICE MANAGER) |
| NPI Enumeration Date | 05/07/2007 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
12 |
$19.24 |
| 2022 |
60 |
$2K |
| 2023 |
43 |
$639.14 |
| 2024 |
28 |
$637.29 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
72 |
71 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
40 |
39 |
$38.48 |
| D0274 |
Bitewings - four radiographic images |
16 |
16 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
13 |
$0.00 |