RIVERVIEW PEDIATRIC DENTAL CARE PC

NPI: 1922696939 · RIVERVIEW, MI 48193 · Pediatric Dentist · NPI assigned 01/05/2021

$91K

Total Medicaid Paid

2,979

Total Claims

2,696

Beneficiaries

Codes Billed

2021-08

First Month

2023-02

Last Month

Provider Details

Authorized Official	OUEIS, HASSAN (OWNER)
NPI Enumeration Date	01/05/2021

Other providers sharing the same authorized official: OUEIS, HASSAN

Provider	City	State	Total Paid
CHILDREN'S DENTAL CARE PLLC	DEARBORN	MI	$37.53M
CHILDREN'S DENTAL CARE OF CANTON	CANTON	MI	$3.34M
CHILDREN DENTAL SPECIALISTS	LIVONIA	MI	$3.13M
ROYAL OAK SURGICAL CENTER, LLC	ROYAL OAK	MI	$428K
CHILDRENS DENTAL CARE OF DETROIT	DETROIT	MI	$322K

Code	Description	Claims	Beneficiaries	Total Paid
D1120	Prophylaxis - child	648	648	$27K
D1206	Topical application of fluoride varnish	673	673	$19K
D0120	Periodic oral evaluation - established patient	419	419	$14K
D0230	Intraoral - periapical each additional radiographic image	496	225	$7K
D0272	Bitewings - two radiographic images	286	286	$6K
D0150	Comprehensive oral evaluation - new or established patient	102	102	$6K
D0220	Intraoral - periapical first radiographic image	306	304	$6K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	31	27	$4K
D2391	Resin-based composite - one surface, posterior, primary or permanent	18	12	$2K