SUMMIT DENTAL HEALTH - BRENTWOOD LLC
NPI: 1154739613
· LA VISTA, NE 68128
· 1223G0001X
$1.79M
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
4,973 |
$73K |
| 2019 |
6,954 |
$113K |
| 2020 |
6,482 |
$94K |
| 2021 |
10,365 |
$192K |
| 2022 |
14,441 |
$479K |
| 2023 |
12,926 |
$498K |
| 2024 |
9,725 |
$344K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
|
2,298 |
1,490 |
$310K |
| D1206 |
|
6,616 |
6,433 |
$224K |
| D0210 |
|
2,665 |
2,664 |
$213K |
| D1110 |
|
3,839 |
3,799 |
$209K |
| D0120 |
|
4,839 |
4,808 |
$171K |
| D0274 |
|
6,534 |
6,467 |
$123K |
| D0150 |
|
3,161 |
3,123 |
$118K |
| D1120 |
|
2,238 |
2,231 |
$87K |
| D2391 |
|
639 |
462 |
$71K |
| D0220 |
|
9,570 |
9,320 |
$59K |
| D1999 |
|
5,710 |
5,268 |
$57K |
| D0230 |
|
12,670 |
8,362 |
$56K |
| D0330 |
|
3,408 |
3,354 |
$27K |
| D2393 |
|
173 |
121 |
$26K |
| D0140 |
|
633 |
604 |
$24K |
| D1351 |
|
249 |
63 |
$10K |
| D0272 |
|
592 |
589 |
$8K |
| D4355 |
|
14 |
14 |
$622.18 |
| D9230 |
|
18 |
13 |
$420.00 |