ALL OUT WISDOM TEETH, LLC
NPI: 1083289128
· SAINT GEORGE, UT 84790
· Dental Clinic/Center
· NPI assigned 05/21/2021
$103K
Total Medicaid Paid
Provider Details
| Authorized Official | EMETT, JASON (MANAGER) |
| NPI Enumeration Date | 05/21/2021 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
586 |
$23K |
| 2023 |
2,298 |
$78K |
| 2024 |
46 |
$1K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
776 |
258 |
$39K |
| D0330 |
Panoramic radiographic image |
568 |
479 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
534 |
447 |
$14K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
298 |
201 |
$14K |
| D9222 |
|
240 |
208 |
$10K |
| D7240 |
Removal of impacted tooth - completely bony |
94 |
30 |
$8K |
| D9612 |
|
249 |
209 |
$544.00 |
| D7921 |
|
171 |
140 |
$0.00 |