NPI: 1912405119 · COVINA, CA 91723 · Dental Clinic/Center · NPI assigned 01/23/2018
| Authorized Official | MEMBRENO, NELLIE (FRONT OFFICE/MANAGER) |
| NPI Enumeration Date | 01/23/2018 |
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 35 | $2K |
| 2022 | 65 | $4K |
| 2023 | 209 | $4K |
| 2024 | 170 | $5K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 69 | 69 | $6K |
| D0120 | Periodic oral evaluation - established patient | 56 | 56 | $5K |
| D1206 | Topical application of fluoride varnish | 118 | 118 | $2K |
| D0230 | Intraoral - periapical each additional radiographic image | 164 | 32 | $684.45 |
| D0274 | Bitewings - four radiographic images | 26 | 26 | $561.60 |
| D0350 | 46 | 14 | $422.40 |