Clinic
Surprise Pediatric Dentistry, PC
Surprise Pediatric Dentistry, PC was paid $86K by Medicaid between Jan 2018 and Dec 2024, across 22 billing codes. Its largest line is D1120, dental cleaning, child — 25% of everything it billed.
33Billing provider infoSURPRISE PEDIATRIC DENTISTRY, PC
SURPRISE, AZ 85374
SURPRISE, AZ 85374
33aNPI1114462330assigned 12/23/2016
33bProvider typeDental Clinic/Center
28Total paid$86K
24GClaims34,900
24DCodes billed22
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Dental Clinic/Center providers in Arizona
Rank by total paid#22 of 70
Median peer was paid$7K
This provider vs. median12×
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 | 3,852 | $21K | |
| 2019 | 1,545 | $16K | |
| 2020 | 5,366 | $21K | |
| 2021 | 7,949 | $18K | |
| 2022 | 5,635 | $6K | |
| 2023 | 4,903 | $3K | |
| 2024incomplete | 5,650 | $0.00 |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 25% | 5,388 | 5,332 | $22K |
| D1206 | Topical application of fluoride varnish | 12% | 5,780 | 5,722 | $10K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 11% | 923 | 399 | $10K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 9.0% | 4,264 | 4,214 | $8K |
| D0272 | Bitewings - two radiographic images | 8.8% | 4,210 | 4,146 | $8K |
| D0150 | Comprehensive oral evaluation - new or established patient | 7.7% | 1,407 | 1,380 | $7K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 4.1% | 1,479 | 1,406 | $4K |
| D0220 | Intraoral - periapical first radiographic image | 4.0% | 3,655 | 3,581 | $3K |
| D0230 | Intraoral - periapical each additional radiographic image | 2.9% | 3,092 | 2,968 | $2K |
| D1351 | Sealant - per tooth | 2.8% | 1,119 | 334 | $2K |
| D0330 | Panoramic radiographic image | 2.7% | 601 | 594 | $2K |
| D7140 | Extraction, erupted tooth or exposed root | 2.2% | 162 | 87 | $2K |
10 more codes
| D0210 | Intraoral - complete series of radiographic images | 2.2% | 120 | $2K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 1.6% | 127 | $1K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 1.4% | 259 | $1K |
| D0274 | Bitewings - four radiographic images | <1% | 436 | $649.76 |
| D0140 | Limited oral evaluation - problem focused | <1% | 208 | $490.42 |
| D1110 | Prophylaxis - adult | <1% | 211 | $333.29 |
| D0601 | 0% | 31 | $0.00 | |
| D0603 | 0% | 1,221 | $0.00 | |
| D0602 | 0% | 131 | $0.00 | |
| D1354 | 0% | 76 | $0.00 |
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 officialJENSEN, MATHEW (DENTIST/OWNER)