Dental
Holly Tree Pediatric Dentistry
Holly Tree Pediatric Dentistry was paid $4.03M by Medicaid between Jan 2018 and Dec 2024, across 21 billing codes. Its largest line is D1120, dental cleaning, child — 19% of everything it billed.
33Billing provider infoHOLLY TREE PEDIATRIC DENTISTRY
SIMPSONVILLE, SC 29681
SIMPSONVILLE, SC 29681
33aNPI1083008890assigned 03/19/2015
33bProvider typePediatric Dentist
28Total paid$4.03M
24GClaims119,586
24DCodes billed21
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in South Carolina
Rank by total paid#17 of 86
Median peer was paid$1.24M
This provider vs. median3.3×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 10,479 | $314K | |
| 2019 | 11,945 | $379K | |
| 2020 | 10,723 | $334K | |
| 2021 | 15,969 | $506K | |
| 2022 | 20,530 | $698K | |
| 2023 | 21,212 | $670K | |
| 2024incomplete | 28,728 | $1.13M |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 19% | 21,593 | 21,593 | $759K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 12% | 19,818 | 19,818 | $472K |
| D1206 | Topical application of fluoride varnish | 10% | 25,350 | 25,350 | $420K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 9.4% | 3,570 | 2,373 | $378K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 6.4% | 1,944 | 1,192 | $256K |
| D0272 | Bitewings - two radiographic images | 5.4% | 11,463 | 11,463 | $220K |
| D1110 | Prophylaxis - adult | 5.4% | 4,285 | 4,285 | $217K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 4.9% | 6,053 | 5,963 | $196K |
| D7140 | Extraction, erupted tooth or exposed root | 4.8% | 1,757 | 1,014 | $192K |
| D1351 | Sealant - per tooth | 4.4% | 5,817 | 1,702 | $177K |
| D0150 | Comprehensive oral evaluation - new or established patient | 4.1% | 3,959 | 3,959 | $163K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 3.7% | 1,632 | 1,229 | $149K |
9 more codes
| D0145 | Oral evaluation for a patient under three years of age | 3.1% | 2,547 | $123K |
| D0330 | Panoramic radiographic image | 2.6% | 1,987 | $103K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 1.7% | 843 | $70K |
| D0220 | Intraoral - periapical first radiographic image | 1.4% | 4,513 | $58K |
| D9223 | Deep sedation/general anesthesia - each subsequent 15 minute increment | <1% | 265 | $25K |
| D0140 | Limited oral evaluation - problem focused | <1% | 458 | $18K |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 1,537 | $17K |
| D9222 | <1% | 123 | $14K | |
| D9310 | <1% | 72 | $5K |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialBYNUM, ANN (PRESIDENT)