CHARLOTTESVILLE ORAL SURGERY AND DENTAL IMPLANT CENTER, LLC
NPI: 1972740454
· CHARLOTTESVILLE, VA 22911
· Oral and Maxillofacial Surgery (Dentist)
· NPI assigned 01/20/2009
$204K
Total Medicaid Paid
Provider Details
| Authorized Official | IBANEZ, CARLOS (PRESIDENT) |
| NPI Enumeration Date | 01/20/2009 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
25 |
$620.75 |
| 2019 |
81 |
$2K |
| 2020 |
60 |
$3K |
| 2021 |
82 |
$4K |
| 2022 |
848 |
$97K |
| 2023 |
1,674 |
$98K |
| 2024 |
354 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
568 |
183 |
$119K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
967 |
350 |
$45K |
| D9222 |
|
359 |
350 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
766 |
759 |
$14K |
| D9610 |
|
344 |
335 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
13 |
$5K |
| D0330 |
Panoramic radiographic image |
87 |
87 |
$809.85 |