SPECIALIZED DENTAL SERVICES-JEFFERSON MALL, PLLC
NPI: 1033397914
· LOUISVILLE, KY 40219
· Oral and Maxillofacial Surgery (Dentist)
· NPI assigned 02/04/2008
$1.69M
Total Medicaid Paid
10,245
Beneficiary Records
Provider Details
| Authorized Official | REIBEL, JEFFREY (CHIEF FINANCIAL OFFICER) |
| NPI Enumeration Date | 02/04/2008 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
1,243 |
$111K |
| 2021 |
4,447 |
$362K |
| 2022 |
5,207 |
$453K |
| 2023 |
3,537 |
$387K |
| 2024 |
3,027 |
$375K |
Billing Codes
| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,870 |
1,088 |
$524K |
| D7240 |
Removal of impacted tooth - completely bony |
2,120 |
756 |
$475K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,347 |
1,633 |
$285K |
| D9222 |
|
1,712 |
1,636 |
$145K |
| D0140 |
Limited oral evaluation - problem focused |
2,616 |
2,523 |
$109K |
| D0330 |
Panoramic radiographic image |
1,665 |
1,617 |
$90K |
| D9610 |
|
869 |
829 |
$27K |
| D7220 |
|
153 |
78 |
$17K |
| D7230 |
|
77 |
53 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32 |
32 |
$2K |