CLINICA DENTAL DRA. CARLA FIDALGO,CSP
NPI: 1942503792
· VEGA ALTA, PR 00692
· Dental Clinic/Center
· NPI assigned 12/17/2010
$521K
Total Medicaid Paid
Provider Details
| Authorized Official | FIDALGO, CARLA (DENTIST) |
| NPI Enumeration Date | 12/17/2010 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
2,005 |
$34K |
| 2019 |
1,610 |
$30K |
| 2020 |
1,637 |
$36K |
| 2021 |
3,008 |
$58K |
| 2022 |
4,589 |
$93K |
| 2023 |
4,588 |
$90K |
| 2024 |
8,618 |
$180K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,022 |
4,895 |
$168K |
| D1999 |
|
6,601 |
5,102 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
4,980 |
3,981 |
$71K |
| D0272 |
Bitewings - two radiographic images |
3,438 |
2,830 |
$50K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,055 |
620 |
$42K |
| D0330 |
Panoramic radiographic image |
1,198 |
969 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,206 |
1,091 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,063 |
874 |
$15K |
| D2160 |
|
178 |
149 |
$7K |
| D2140 |
|
210 |
121 |
$7K |
| D1120 |
Prophylaxis - child |
104 |
89 |
$2K |