EASTSIDE DRAKE SMILES PC

NPI: 1043990278 · SIOUX FALLS, SD 57108 · General Practice Dentistry · NPI assigned 07/21/2023

$50K

Total Medicaid Paid

927

Total Claims

511

Beneficiaries

Codes Billed

2024-08

First Month

2024-12

Last Month

Provider Details

Authorized Official	DRAKE, VALERIE (PRESIDENT)
NPI Enumeration Date	07/21/2023

Other providers sharing the same authorized official: DRAKE, VALERIE

Provider	City	State	Total Paid
FETTIG AND DRAKE DDS PC	ABERDEEN	SD	$1.05M
RGV DENTAL, PLLC	SAN BENITO	TX	$82K
REDFIELD DRAKE FAMILY DENTISTRY PC	REDFIELD	SD	$77K
ANKENBRANDT AND DRAKE DDS PC	HURON	SD	$24K
DRAKE AND ANKENBRANDT PEDIATRIC DENTISTRY OF ABERDEEN PC	ABERDEEN	SD	$5K
DRAKE AND ANKENBRANDT PEDIATRIC DENTISTRY OF HURON PC	HURON	SD	$2K

Year	Claims	Total Paid
2024	927	$50K

Code	Description	Claims	Beneficiaries	Total Paid
D1351	Sealant - per tooth	452	56	$19K
D0150	Comprehensive oral evaluation - new or established patient	115	115	$7K
D1110	Prophylaxis - adult	80	80	$6K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	32	15	$5K
D0330	Panoramic radiographic image	45	45	$4K
D1206	Topical application of fluoride varnish	103	103	$3K
D0274	Bitewings - four radiographic images	54	54	$3K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	18	15	$794.88
D0220	Intraoral - periapical first radiographic image	15	15	$331.38
D0230	Intraoral - periapical each additional radiographic image	13	13	$235.92