K.SUMARDI DDS INC.
NPI: 1942603105
· LA VERNE, CA 91750
· General Practice Dentistry
· NPI assigned 10/02/2014
Provider Details
| Authorized Official | SUMARDI, KUSUMO (PRESIDENT) |
| NPI Enumeration Date | 10/02/2014 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
183 |
$3K |
| 2023 |
90 |
$1K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
28 |
28 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$858.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
179 |
58 |
$724.95 |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$540.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
26 |
26 |
$413.00 |