LITTLE RIVER MEDICAL CENTER INC

$3.95M

Total Medicaid Paid

126,025

Total Claims

117,885

Beneficiaries

22

Codes Billed

2018-01

First Month

2024-12

Last Month

Authorized Official	CRISWELL, AVANGELA (BUSINESS OFFICE DIRECTOR)
Parent Organization	LITTLE RIVER MEDICAL CENTER, INC.
NPI Enumeration Date	12/12/2006

Provider	City	State	Total Paid
LITTLE RIVER MEDICAL CENTER, INC.	MYRTLE BEACH	SC	$665K
LITTLE RIVER MEDICAL CENTER, INC.	MYRTLE BEACH	SC	$341K

Code	Description	Claims	Beneficiaries	Total Paid
D1120	Prophylaxis - child	16,934	16,934	$593K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	5,381	4,004	$578K
D0120	Periodic oral evaluation - established patient	18,679	18,679	$440K
D1110	Prophylaxis - adult	7,221	7,221	$361K
D1206	Topical application of fluoride varnish	20,588	20,588	$349K
D0272	Bitewings - two radiographic images	13,420	13,420	$267K
D1351	Sealant - per tooth	8,487	2,838	$255K
D0140	Limited oral evaluation - problem focused	6,125	6,111	$231K
D0150	Comprehensive oral evaluation - new or established patient	5,570	5,570	$229K
D0274	Bitewings - four radiographic images	7,763	7,763	$204K
D2391	Resin-based composite - one surface, posterior, primary or permanent	1,871	1,476	$151K
D0220	Intraoral - periapical first radiographic image	9,129	9,080	$118K
D0330	Panoramic radiographic image	1,370	1,370	$68K
D2150	Silver amalgam - two surfaces, primary or permanent	438	251	$37K
D7140	Extraction, erupted tooth or exposed root	196	141	$17K
D0230	Intraoral - periapical each additional radiographic image	1,506	1,348	$16K
D1208	Topical application of fluoride, excluding varnish	535	535	$9K
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	60	53	$8K
D0210	Intraoral - complete series of radiographic images	140	140	$7K
D2930	Prefabricated stainless steel crown - primary tooth	54	45	$7K
D1354		475	247	$5K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	83	71	$3K

Medicaid Provider Spending