Dental
Kingston Dental LLC
Kingston Dental LLC was paid $305K by Medicaid between Jan 2018 and Jul 2018, across 15 billing codes. Its largest line is D2392, Resin-based composite - two surfaces, posterior, primary or permanent — 15% of everything it billed.
33Billing provider infoKINGSTON DENTAL LLC
KINGSTON, TN 37763
KINGSTON, TN 37763
33aNPI1083860498assigned 08/18/2008
33bProvider typeGeneral Practice Dentistry
28Total paid$305K
24GClaims12,134
24DCodes billed15
24AFirst – last monthJan 2018 – Jul 2018
Compared with peers
Next to other General Practice Dentistry providers in Tennessee
Rank by total paid#126 of 336
Median peer was paid$123K
This provider vs. median2.5×
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 | 12,134 | $305K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 15% | 671 | 382 | $47K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 12% | 1,567 | 1,566 | $38K |
| D1120 | Dental cleaning, childProphylaxis - child | 12% | 1,105 | 1,104 | $37K |
| D1208 | Topical application of fluoride, excluding varnish | 11% | 1,689 | 1,687 | $33K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 9.3% | 477 | 341 | $28K |
| D1110 | Prophylaxis - adult | 8.7% | 614 | 614 | $26K |
| D0274 | Bitewings - four radiographic images | 8.6% | 944 | 943 | $26K |
| D0230 | Intraoral - periapical each additional radiographic image | 7.0% | 2,309 | 1,581 | $21K |
| D0220 | Intraoral - periapical first radiographic image | 7.0% | 1,696 | 1,685 | $21K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 3.4% | 354 | 302 | $10K |
| D0272 | Bitewings - two radiographic images | 3.1% | 523 | 523 | $10K |
| D0150 | Comprehensive oral evaluation - new or established patient | <1% | 101 | 101 | $3K |
3 more codes
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 officialHULSE, EVON (BOARD MEMBER)