WHITE OAK FAMILY DENTAL PLLC

NPI: 1013422047 · DENTON, TX 76208 · Orthodontics and Dentofacial Orthopedic Dentist · NPI assigned 12/13/2017

$46K

Total Medicaid Paid

3,059

Total Claims

2,704

Beneficiaries

Codes Billed

2021-01

First Month

2024-10

Last Month

Provider Details

Authorized Official	MAHONEY, KACEY (OWNER)
NPI Enumeration Date	12/13/2017

Other providers sharing the same authorized official: MAHONEY, KACEY

Provider	City	State	Total Paid
HASLET FAMILY DENTAL PLLC	HASLET	TX	$91K
TODAY DENTAL OF SAGINAW PLLC	FORT WORTH	TX	$53K
CROWLEY STONE OAK PLLC	CROWLEY	TX	$40K
OAK VIEW FAMILY DENTISTRY PLLC	FORT WORTH	TX	$26K
TODAY DENTAL OF MANSFIELD NORTH PLLC	MANSFIELD	TX	$5K
ACMA DENTAL GROUP PLLC	FORT WORTH	TX	$2K
TODAY DENTAL OF GOLDEN TRIANGLE PLLC	FORT WORTH	TX	$0.00

Code	Description	Claims	Beneficiaries	Total Paid
D0120	Periodic oral evaluation - established patient	311	309	$9K
D0274	Bitewings - four radiographic images	266	257	$7K
D0230	Intraoral - periapical each additional radiographic image	662	432	$6K
D1208	Topical application of fluoride, excluding varnish	425	422	$6K
D0220	Intraoral - periapical first radiographic image	475	466	$5K
D1110	Prophylaxis - adult	95	95	$5K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	34	14	$3K
D1120	Prophylaxis - child	80	80	$3K
D1351	Sealant - per tooth	80	14	$2K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	14	12	$379.54
D0272	Bitewings - two radiographic images	12	12	$257.18
D0601		605	591	$0.00