BRADSHAW MOUNTAIN FAMILY DENTAL GROUP PC
NPI: 1972773141
· PRESCOTT VALLEY, AZ 86314
· Dental Clinic/Center
· NPI assigned 03/04/2008
Provider Details
| Authorized Official | FRAUSTO, DAVID (PRESIDENT) |
| NPI Enumeration Date | 03/04/2008 |
Related Entities
Other providers sharing the same authorized official: FRAUSTO, DAVID
| Provider | City | State | Total Paid |
|---|
| SEASONS SAGE |
CHINO VALLEY |
AZ |
$7K |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
200 |
$4K |
| 2019 |
343 |
$494.24 |
| 2020 |
681 |
$216.64 |
| 2021 |
200 |
$0.00 |
| 2022 |
497 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
389 |
387 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
404 |
402 |
$1K |
| D1110 |
Prophylaxis - adult |
277 |
277 |
$828.67 |
| D0274 |
Bitewings - four radiographic images |
207 |
207 |
$561.84 |
| D0220 |
Intraoral - periapical first radiographic image |
370 |
366 |
$447.34 |
| D0230 |
Intraoral - periapical each additional radiographic image |
150 |
150 |
$296.67 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
74 |
26 |
$170.98 |
| D0601 |
|
38 |
38 |
$0.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$0.00 |