Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers

MAINE TINY DENTAL LLC

NPI: 1124877147 · NEW SHARON, ME 04955 · Dental Hygienist · NPI assigned 05/13/2024

$159K
Total Medicaid Paid
6,449
Total Claims
1,682
Beneficiaries
19
Codes Billed
2024-08
First Month
2024-12
Last Month

Provider Details

Authorized OfficialDESOUZA, KELLI (INDEPENDENT DENTAL HYGIENIST)
NPI Enumeration Date05/13/2024

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2024 6,449 $159K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D1355 4,344 184 $88K
D4341 68 27 $11K
D2940 138 37 $8K
D0230 Intraoral - periapical each additional radiographic image 445 125 $7K
D0190 317 288 $7K
D0210 Intraoral - complete series of radiographic images 71 71 $7K
D1110 Prophylaxis - adult 90 89 $6K
D1310 220 218 $6K
D0220 Intraoral - periapical first radiographic image 182 134 $4K
D0274 Bitewings - four radiographic images 80 79 $4K
D4355 28 28 $3K
D1320 72 69 $2K
D1206 Topical application of fluoride varnish 79 74 $2K
D1351 Sealant - per tooth 66 15 $2K
D4346 16 15 $883.22
D1120 Prophylaxis - child 14 13 $655.80
D0272 Bitewings - two radiographic images 16 15 $567.20
D0602 117 115 $0.00
D0603 86 86 $0.00