STANISLAV KOVTUN, DMD PC
NPI: 1922462100
· BROOKLINE, MA 02446
· General Practice Dentistry
· NPI assigned 04/13/2016
$246K
Total Medicaid Paid
Provider Details
Related Entities
Other providers sharing the same authorized official: KOVTUN, STANISLAV
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,182 |
$45K |
| 2019 |
1,222 |
$44K |
| 2020 |
696 |
$25K |
| 2021 |
782 |
$29K |
| 2022 |
723 |
$30K |
| 2023 |
616 |
$42K |
| 2024 |
699 |
$32K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,448 |
2,417 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
1,909 |
1,889 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
644 |
628 |
$25K |
| D2740 |
Crown - porcelain/ceramic |
22 |
13 |
$17K |
| D0274 |
Bitewings - four radiographic images |
442 |
437 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
196 |
190 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
133 |
130 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
55 |
53 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
57 |
55 |
$849.00 |
| D9110 |
|
14 |
14 |
$504.00 |