EAGLE MOUNTAIN CHILDREN'S DENTISTRY PLLC
NPI: 1922573856
· EAGLE MOUNTAIN, UT 84005
· Dental Clinic/Center
· NPI assigned 10/08/2018
$117K
Total Medicaid Paid
Provider Details
| Authorized Official | ROOKLIDGE, ERIK (PRESIDENT) |
| NPI Enumeration Date | 10/08/2018 |
Related Entities
Other providers sharing the same authorized official: ROOKLIDGE, ERIK
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
1,119 |
$31K |
| 2022 |
1,724 |
$43K |
| 2023 |
981 |
$26K |
| 2024 |
549 |
$16K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
875 |
866 |
$66K |
| D1120 |
Prophylaxis - child |
1,179 |
1,169 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
89 |
$11K |
| D0272 |
Bitewings - two radiographic images |
862 |
854 |
$8K |
| D1206 |
Topical application of fluoride varnish |
1,204 |
1,191 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
54 |
25 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
45 |
45 |
$208.72 |
| D0330 |
Panoramic radiographic image |
43 |
41 |
$0.00 |