Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › TX › LAKEWAY › KING SMILES

KING SMILES

NPI: 1134300163 · LAKEWAY, TX 78734 · General Practice Dentistry · NPI assigned 11/19/2007

$946.68
Total Medicaid Paid
70
Total Claims
70
Beneficiaries
5
Codes Billed
2018-03
First Month
2018-03
Last Month

Provider Details

Authorized OfficialISTRE, MICHAEL (OWNER)
NPI Enumeration Date11/19/2007

Related Entities

Other providers sharing the same authorized official: ISTRE, MICHAEL

ProviderCityStateTotal Paid
SS POWERS DENTAL, P.A. AUSTIN TX $303K
SHANE ISTRE DENTAL ASSOCIATES AUSTIN TX $216K
S & P DENTAL AUSTIN TX $148K
S AND S DENTAL AUSTIN TX $113K
I & J DENTAL AUSTIN TX $103K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 70 $946.68

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D0120 Periodic oral evaluation - established patient 14 14 $403.90
D1208 Topical application of fluoride, excluding varnish 14 14 $205.80
D0220 Intraoral - periapical first radiographic image 14 14 $175.84
D0230 Intraoral - periapical each additional radiographic image 14 14 $161.14
D0603 14 14 $0.00