Dental
Tidewater LLC
Tidewater LLC was paid $188K by Medicaid between Aug 2021 and Dec 2024, across 14 billing codes. Its largest line is D2392, Resin-based composite - two surfaces, posterior, primary or permanent — 29% of everything it billed.
33Billing provider infoTIDEWATER LLC
CHARLOTTE HALL, MD 20622
CHARLOTTE HALL, MD 20622
33aNPI1144884560assigned 05/01/2019
33bProvider typeGeneral Practice Dentistry
28Total paid$188K
24GClaims2,575
24DCodes billed14
24AFirst – last monthAug 2021 – Dec 2024
Compared with peers
Next to other General Practice Dentistry providers in Maryland
Rank by total paid#175 of 598
Median peer was paid$42K
This provider vs. median4.5×
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 | 25 | $573.16 | |
| 2022 | 92 | $3K | |
| 2023 | 584 | $31K | |
| 2024incomplete | 1,874 | $154K |
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 | 29% | 398 | 178 | $55K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 27% | 291 | 110 | $50K |
| D0150 | Comprehensive oral evaluation - new or established patient | 14% | 451 | 451 | $25K |
| D1110 | Prophylaxis - adult | 8.6% | 241 | 241 | $16K |
| D0210 | Intraoral - complete series of radiographic images | 8.4% | 275 | 275 | $16K |
| D0140 | Limited oral evaluation - problem focused | 4.3% | 172 | 170 | $8K |
| D1206 | Topical application of fluoride varnish | 3.1% | 239 | 237 | $6K |
| D0220 | Intraoral - periapical first radiographic image | 1.9% | 299 | 295 | $4K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 1.5% | 88 | 88 | $3K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 1.5% | 26 | 14 | $3K |
| D1120 | Dental cleaning, childProphylaxis - child | <1% | 29 | 29 | $1K |
| D0274 | Bitewings - four radiographic images | <1% | 25 | 25 | $601.75 |
2 more codes
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 officialWILSON, SIMONE (DIRECTOR OF CREDENTIALING & ENROLL)
Parent organizationTIDEWATER, LLC