BOYLSTON STREET DENTAL, LLC
NPI: 1922513597
· CHESTNUT HILL, MA 02467
· Dentist
· NPI assigned 12/05/2017
$281K
Total Medicaid Paid
Provider Details
| Authorized Official | POLIVY, ADAM (PARTNER) |
| NPI Enumeration Date | 12/05/2017 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,100 |
$27K |
| 2019 |
1,251 |
$40K |
| 2020 |
912 |
$29K |
| 2021 |
1,525 |
$48K |
| 2022 |
1,904 |
$60K |
| 2023 |
1,615 |
$49K |
| 2024 |
878 |
$27K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,036 |
1,986 |
$95K |
| D1206 |
Topical application of fluoride varnish |
3,576 |
3,475 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
3,158 |
3,068 |
$81K |
| D1110 |
Prophylaxis - adult |
333 |
322 |
$19K |
| D1351 |
Sealant - per tooth |
43 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$672.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$598.00 |