RUSTOM, SARAH
NPI: 1912640699
· MARRERO, LA 70072
· General Practice Dentistry
· NPI assigned 04/19/2022
$754.28
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2024 |
166 |
$754.28 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
32 |
15 |
$317.35 |
| D1208 |
Topical application of fluoride, excluding varnish |
40 |
19 |
$161.70 |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
16 |
$149.63 |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
17 |
$125.60 |