JACOBS, JONATHAN
NPI: 1972563609
· ST CLAIR SHORES, MI 48080
· General Practice Dentistry
· NPI assigned 03/25/2006
$577.51
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
24 |
$323.03 |
| 2019 |
12 |
$254.48 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
24 |
24 |
$425.13 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$152.38 |