Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
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DENTAL DEPOT OF BLUE SPRINGS PLLC

NPI: 1164033122 · BLUE SPRINGS, MO 64014 · Dental Clinic/Center · NPI assigned 08/13/2020

Billing Flags · Automated signals — not evidence of fraud
Entity Proliferation

Authorized official ZISSA, GAYLON controls 13+ related entities in our dataset. Read more

$21K
Total Medicaid Paid
1,937
Total Claims
1,388
Beneficiaries
12
Codes Billed
2020-12
First Month
2024-12
Last Month

Provider Details

Authorized OfficialZISSA, GAYLON (PROFESSIONAL RELATIONS MANAGER)
NPI Enumeration Date08/13/2020

Related Entities

Other providers sharing the same authorized official: ZISSA, GAYLON

ProviderCityStateTotal Paid
DENTAL DEPOT SOUTH OKLAHOMA CITY OK $3.40M
DENTAL DEPOT ORTHODONTICS CENTRAL OKC PLLC OKLAHOMA CITY OK $3.31M
DENTAL DEPOT ORTHODONTICS SOUTH PLLC OKLAHOMA CITY OK $2.53M
DENTAL DEPOT OF I-44 & GARNETT, PLLC TULSA OK $1.34M
DENTAL DEPOT ORTHODONTICS NORTH OKC PLLC OKLAHOMA CITY OK $1.22M
DENTAL DEPOT ORTHODONTICS YUKON PLLC YUKON OK $1.04M
DENTAL DEPOT OF 164TH & PORTLAND PLLC OKLAHOMA CITY OK $546K
DENTAL DEPOT OF DEL CITY, PLLC DEL CITY OK $438K
DENTAL DEPOT ORTHODONTICS TECUMSEH, PLLC NORMAN OK $107K
DENTAL DEPOT OF ARLINGTON PLLC ARLINGTON TX $31K
DENTAL DEPOT ORTHODONTICS DEL CITY, PLLC DEL CITY OK $21K
DENTAL DEPOT OF INDEPENDENCE, PLLC INDEPENDENCE MO $6K
DENTAL DEPOT OF MUSTANG, PLLC OKLAHOMA CITY OK $5K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2020 252 $0.00
2021 664 $4K
2022 37 $340.09
2023 233 $5K
2024 751 $12K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D0274 Bitewings - four radiographic images 264 216 $6K
D0220 Intraoral - periapical first radiographic image 530 415 $6K
D0230 Intraoral - periapical each additional radiographic image 561 296 $5K
D0330 Panoramic radiographic image 134 109 $1K
D0150 Comprehensive oral evaluation - new or established patient 133 106 $1K
D1110 Prophylaxis - adult 41 29 $686.28
D0140 Limited oral evaluation - problem focused 31 28 $666.05
D0120 Periodic oral evaluation - established patient 24 18 $511.20
D0350 19 12 $124.80
D1208 Topical application of fluoride, excluding varnish 46 42 $0.00
D1120 Prophylaxis - child 36 35 $0.00
D1999 118 82 $0.00