Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › VA › ARLINGTON › CRYSTAL CITY DENTAL ARTS CENTER

CRYSTAL CITY DENTAL ARTS CENTER

NPI: 1932467180 · ARLINGTON, VA 22202 · General Practice Dentistry · NPI assigned 04/25/2012

$13K
Total Medicaid Paid
460
Total Claims
454
Beneficiaries
5
Codes Billed
2020-02
First Month
2024-04
Last Month

Provider Details

Authorized OfficialFAVAGEHI, JASON (PRESIDENT)
NPI Enumeration Date04/25/2012

Related Entities

Other providers sharing the same authorized official: FAVAGEHI, JASON

ProviderCityStateTotal Paid
JASON FARR FAVAGEHI DDS III PC CHANTILLY VA $34K
JASON FARR FAVAGEHI DDC PC VIENNA VA $12K
JASON F FAVAGEHI DDS PC ARLINGTON VA $3K
CRYSTAL SMILE, PLLC ARLINGTON VA $1K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2020 12 $125.24
2021 92 $3K
2022 125 $4K
2023 202 $5K
2024 29 $0.00

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D1110 Prophylaxis - adult 226 223 $8K
D0120 Periodic oral evaluation - established patient 122 120 $2K
D0274 Bitewings - four radiographic images 57 57 $2K
D0150 Comprehensive oral evaluation - new or established patient 37 37 $857.84
D0220 Intraoral - periapical first radiographic image 18 17 $261.54