Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers

CEDAR SPRINGS DENTAL PLLC

NPI: 1053087536 · CEDAR SPRINGS, MI 49319 · Dental Clinic/Center · NPI assigned 08/17/2021

$75K
Total Medicaid Paid
2,844
Total Claims
2,834
Beneficiaries
9
Codes Billed
2021-10
First Month
2024-12
Last Month

Provider Details

Authorized OfficialSETAPUTRI, ANDRES (DENTIST)
NPI Enumeration Date08/17/2021

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2021 110 $4K
2022 881 $24K
2023 991 $26K
2024 862 $21K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D1120 Prophylaxis - child 698 697 $23K
D0120 Periodic oral evaluation - established patient 841 841 $19K
D1206 Topical application of fluoride varnish 860 860 $18K
D1110 Prophylaxis - adult 179 179 $7K
D0274 Bitewings - four radiographic images 100 100 $2K
D0150 Comprehensive oral evaluation - new or established patient 73 73 $2K
D2392 Resin-based composite - two surfaces, posterior, primary or permanent 22 13 $2K
D0272 Bitewings - two radiographic images 43 43 $912.00
D0220 Intraoral - periapical first radiographic image 28 28 $323.50