Dental
Primary Teeth Pediatric Dentistry PLLC
Primary Teeth Pediatric Dentistry PLLC was paid $2.17M by Medicaid between Mar 2021 and Dec 2024, across 24 billing codes. Its largest line is D2392, Resin-based composite - two surfaces, posterior, primary or permanent — 20% of everything it billed.
33Billing provider infoPRIMARY TEETH PEDIATRIC DENTISTRY PLLC
GLOVERSVILLE, NY 12078
GLOVERSVILLE, NY 12078
33aNPI1114548617assigned 05/06/2020
33bProvider typePediatric Dentist
28Total paid$2.17M
24GClaims50,320
24DCodes billed24
24AFirst – last monthMar 2021 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in New York
Rank by total paid#62 of 514
Median peer was paid$196K
This provider vs. median11×
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 | |
|---|---|---|---|
| 2021 | 4,093 | $199K | |
| 2022 | 11,384 | $543K | |
| 2023 | 15,630 | $671K | |
| 2024incomplete | 19,213 | $757K |
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 | 20% | 3,450 | 1,579 | $438K |
| D1120 | Dental cleaning, childProphylaxis - child | 17% | 8,022 | 8,022 | $365K |
| D1351 | Sealant - per tooth | 12% | 3,968 | 1,547 | $255K |
| D1206 | Topical application of fluoride varnish | 11% | 7,310 | 7,310 | $235K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 9.2% | 6,933 | 6,933 | $200K |
| D1110 | Prophylaxis - adult | 6.6% | 2,489 | 2,489 | $142K |
| D0150 | Comprehensive oral evaluation - new or established patient | 4.6% | 3,135 | 3,135 | $99K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 3.2% | 394 | 258 | $70K |
| D0272 | Bitewings - two radiographic images | 2.4% | 3,138 | 3,138 | $53K |
| D7140 | Extraction, erupted tooth or exposed root | 2.2% | 763 | 540 | $49K |
| D1208 | Topical application of fluoride, excluding varnish | 1.9% | 2,854 | 2,854 | $42K |
| D0274 | Bitewings - four radiographic images | 1.9% | 1,411 | 1,411 | $41K |
12 more codes
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 1.7% | 234 | $38K |
| D0330 | Panoramic radiographic image | 1.7% | 910 | $36K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 1.1% | 1,051 | $23K |
| D0240 | 1.0% | 800 | $23K | |
| D0220 | Intraoral - periapical first radiographic image | <1% | 1,476 | $20K |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 507 | $16K |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 752 | $9K |
| D0140 | Limited oral evaluation - problem focused | <1% | 525 | $8K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | <1% | 51 | $3K |
| D9420 | <1% | 30 | $3K | |
| D1354 | <1% | 105 | $2K | |
| D0210 | Intraoral - complete series of radiographic images | <1% | 12 | $100.30 |
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 officialFRIED, JAKE (OWNER)