Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › SD › SIOUX FALLS › BOLEN FAMILY DENTISTRY P.C.

BOLEN FAMILY DENTISTRY P.C.

NPI: 1073819991 · SIOUX FALLS, SD 57105 · Dental Clinic/Center · NPI assigned 02/10/2011

$31K
Total Medicaid Paid
985
Total Claims
982
Beneficiaries
7
Codes Billed
2018-01
First Month
2019-07
Last Month

Provider Details

Authorized OfficialBOLEN, KARI (DIRECTOR/PRESIDENT)
NPI Enumeration Date02/10/2011

Related Entities

Other providers sharing the same authorized official: BOLEN, KARI

ProviderCityStateTotal Paid
BOLEN DENTAL PC CUSTER SD $478.27

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 825 $27K
2019 160 $4K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D0120 Periodic oral evaluation - established patient 415 415 $11K
D1110 Prophylaxis - adult 208 208 $10K
D1206 Topical application of fluoride varnish 204 204 $4K
D1120 Prophylaxis - child 105 105 $4K
D0274 Bitewings - four radiographic images 25 25 $868.59
D9230 Inhalation of nitrous oxide / analgesia, anxiolysis 16 13 $591.20
D0272 Bitewings - two radiographic images 12 12 $321.00