PRAVEEN PAVULURU, DMD, LLC
NPI: 1962133454
· BANGOR, ME 04401
· Dental Clinic/Center
· NPI assigned 06/23/2022
$101K
Total Medicaid Paid
Provider Details
| Authorized Official | PAVULURU, PRAVEEN (SOLE OWNER/MEMBER) |
| NPI Enumeration Date | 06/23/2022 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
343 |
$20K |
| 2023 |
635 |
$44K |
| 2024 |
609 |
$37K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
332 |
332 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
592 |
592 |
$20K |
| D4910 |
|
190 |
190 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
187 |
187 |
$18K |
| D4355 |
|
85 |
85 |
$9K |
| D0274 |
Bitewings - four radiographic images |
165 |
165 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
13 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$2K |