Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › AZ › TAYLOR › RUSTIC MOUNTAIN DENTISTRY

RUSTIC MOUNTAIN DENTISTRY

NPI: 1063983245 · TAYLOR, AZ 85939 · Dental Clinic/Center · NPI assigned 12/16/2018

$0.00
Total Medicaid Paid
125
Total Claims
125
Beneficiaries
6
Codes Billed
2021-07
First Month
2022-07
Last Month

Provider Details

Authorized OfficialDAVIS, KENNETH (DOCTOR/OWNER)
NPI Enumeration Date12/16/2018

Related Entities

Other providers sharing the same authorized official: DAVIS, KENNETH

ProviderCityStateTotal Paid
PDSSC-CHICAGO, INC. CHICAGO IL $196K
GALENA CLINIC, INC. GALENA IL $59K
ELIZABETH PEDIATRIC GROUP, LLC ELIZABETH NJ $26K
DAVISPSYCHOLOGICAL & CONSULTING SERVICES INC. TOLEDO OH $589.03

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2021 74 $0.00
2022 51 $0.00

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D0120 Periodic oral evaluation - established patient 26 26 $0.00
D1206 Topical application of fluoride varnish 37 37 $0.00
D1120 Prophylaxis - child 25 25 $0.00
D1110 Prophylaxis - adult 12 12 $0.00
D0274 Bitewings - four radiographic images 13 13 $0.00
D0220 Intraoral - periapical first radiographic image 12 12 $0.00