South Ogden Pediatric Dental P.C.

South Ogden Pediatric Dental P.C. was paid $101K by Medicaid between Jan 2018 and Aug 2024, across 7 billing codes. Its largest line is D0120, dental checkup, returning patient — 33% of everything it billed.

33Billing provider infoSOUTH OGDEN PEDIATRIC DENTAL P.C.
WASHINGTON TERRACE, UT 84405

33aNPI1104834191assigned 08/04/2006

33bProvider typePediatric Dentist

28Total paid$101K

24GClaims4,307

24DCodes billed7

24AFirst – last monthJan 2018 – Aug 2024

Compared with peers

Next to other Pediatric Dentist providers in Utah

Rank by total paid#113 of 152

Median peer was paid$311K

This provider vs. median0.3×

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	109	$2K
2021	128	$3K
2022	2,043	$52K
2023	1,583	$34K
2024incomplete	444	$10K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	33%	650	644	$33K
D1120	Dental cleaning, childProphylaxis - child	27%	867	859	$27K
D0272	Bitewings - two radiographic images	14%	578	572	$14K
D0150	Comprehensive oral evaluation - new or established patient	9.0%	104	103	$9K
D1206	Topical application of fluoride varnish	8.1%	820	812	$8K
D0220	Intraoral - periapical first radiographic image	5.4%	724	705	$5K
D0230	Intraoral - periapical each additional radiographic image	3.4%	564	553	$3K

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 officialRALLISON, M. (OWNER)