Lake Moultrie Dental LLC

Lake Moultrie Dental LLC was paid $20K by Medicaid between Oct 2020 and Oct 2024, across 8 billing codes. Its largest line is D1110, Prophylaxis - adult — 52% of everything it billed.

33Billing provider infoLAKE MOULTRIE DENTAL LLC
MONCKS CORNER, SC 29461

33aNPI1013482603assigned 10/10/2018

33bProvider typeDental Clinic/Center

28Total paid$20K

24GClaims603

24DCodes billed8

24AFirst – last monthOct 2020 – Oct 2024

Compared with peers

Next to other Dental Clinic/Center providers in South Carolina

Rank by total paid#49 of 68

Median peer was paid$121K

This provider vs. median0.2×

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
2020	49	$2K
2021	87	$2K
2022	169	$6K
2023	245	$7K
2024incomplete	53	$2K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1110	Prophylaxis - adult	52%	209	209	$10K
D0274	Bitewings - four radiographic images	25%	180	180	$5K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	13%	118	118	$3K
D0330	Panoramic radiographic image	2.6%	12	12	$518.55
D0150	Comprehensive oral evaluation - new or established patient	2.3%	12	12	$455.40
D0220	Intraoral - periapical first radiographic image	2.2%	34	33	$438.77
D0230	Intraoral - periapical each additional radiographic image	1.4%	26	26	$270.42
D1208	Topical application of fluoride, excluding varnish	<1%	12	12	$194.40

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 officialJAQUES, BRIAN (OWNER/DENTIST)