ST CLOUD OUTPATIENT SURGERY LTD
NPI: 1124084843
· SAINT CLOUD, MN 56303
· Ambulatory Surgical Clinic/Center
· NPI assigned 04/21/2006
$3.96M
Total Medicaid Paid
Provider Details
| Authorized Official | NAGORSKI, DARCI (CHIEF ADMINISTRATIVE OFFICER) |
| NPI Enumeration Date | 04/21/2006 |
Related Entities
Other providers sharing the same authorized official: NAGORSKI, DARCI
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
2,331 |
$298K |
| 2019 |
859 |
$626K |
| 2020 |
1,206 |
$413K |
| 2021 |
756 |
$247K |
| 2022 |
1,247 |
$689K |
| 2023 |
1,732 |
$968K |
| 2024 |
481 |
$722K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,570 |
1,341 |
$2.16M |
| 69436 |
Tympanostomy (requiring insertion of ventilating tube), general anesthesia |
1,248 |
1,176 |
$1.08M |
| 42820 |
Tonsillectomy and adenoidectomy; younger than age 12 |
457 |
443 |
$502K |
| 41899 |
Unlisted procedure, dentoalveolar structures |
74 |
70 |
$159K |
| 42830 |
|
40 |
40 |
$40K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
802 |
341 |
$24K |
| D3230 |
|
95 |
43 |
$5K |
| D1120 |
Prophylaxis - child |
110 |
107 |
$484.29 |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
26 |
$341.00 |
| D0240 |
|
40 |
24 |
$263.97 |
| D0272 |
Bitewings - two radiographic images |
89 |
85 |
$148.74 |
| L8699 |
Prosthetic implant, not otherwise specified |
13 |
12 |
$0.00 |