Dental
Pediatric Dentristry of Coralville INC
Pediatric Dentristry of Coralville INC was paid $90K by Medicaid between Jan 2018 and Mar 2019, across 16 billing codes. Its largest line is D1120, dental cleaning, child — 22% of everything it billed.
33Billing provider infoPEDIATRIC DENTRISTRY OF CORALVILLE INC
CORALVILLE, IA 52241
CORALVILLE, IA 52241
33aNPI1003823113assigned 08/02/2006
33bProvider typePediatric Dentist
28Total paid$90K
24GClaims4,700
24DCodes billed16
24AFirst – last monthJan 2018 – Mar 2019
Compared with peers
Next to other Pediatric Dentist providers in Iowa
Rank by total paid#44 of 58
Median peer was paid$284K
This provider vs. median0.3×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 4,155 | $80K | |
| 2019 | 545 | $10K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 22% | 794 | 771 | $20K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 19% | 953 | 923 | $17K |
| D1206 | Topical application of fluoride varnish | 14% | 842 | 815 | $12K |
| D1351 | Sealant - per tooth | 10% | 518 | 128 | $9K |
| D1110 | Prophylaxis - adult | 7.5% | 227 | 216 | $7K |
| D0230 | Intraoral - periapical each additional radiographic image | 6.6% | 408 | 293 | $6K |
| D0220 | Intraoral - periapical first radiographic image | 5.6% | 437 | 421 | $5K |
| D0272 | Bitewings - two radiographic images | 5.1% | 262 | 258 | $5K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 3.3% | 41 | 13 | $3K |
| D0274 | Bitewings - four radiographic images | 2.0% | 75 | 74 | $2K |
| D7140 | Extraction, erupted tooth or exposed root | 1.5% | 21 | 12 | $1K |
| D0150 | Comprehensive oral evaluation - new or established patient | 1.3% | 39 | 39 | $1K |
4 more codes
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialIBEN, POLLY (OWNER)