Dental
Fairwood Pedodonticsllc
Fairwood Pedodonticsllc was paid $1.33M by Medicaid between Oct 2021 and Dec 2024, across 22 billing codes. Its largest line is D2391, Resin-based composite - one surface, posterior, primary or permanent — 16% of everything it billed.
33Billing provider infoFAIRWOOD PEDODONTICSLLC
RENTON, WA 98058
RENTON, WA 98058
33aNPI1164197125assigned 08/11/2021
33bProvider typePediatric Dentist
28Total paid$1.33M
24GClaims36,030
24DCodes billed22
24AFirst – last monthOct 2021 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Washington
Rank by total paid#50 of 156
Median peer was paid$337K
This provider vs. median4.0×
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 | 2,133 | $23K | |
| 2022 | 6,152 | $132K | |
| 2023 | 13,103 | $631K | |
| 2024incomplete | 14,642 | $548K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 16% | 3,328 | 668 | $209K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 13% | 2,418 | 702 | $174K |
| D2332 | 12% | 1,393 | 333 | $165K | |
| D2930 | Prefabricated stainless steel crown - primary tooth | 9.6% | 816 | 233 | $128K |
| D2330 | 7.0% | 1,420 | 369 | $93K | |
| D1351 | Sealant - per tooth | 6.2% | 3,746 | 707 | $82K |
| D9630 | 6.2% | 2,015 | 1,912 | $82K | |
| D1206 | Topical application of fluoride varnish | 5.4% | 3,307 | 3,109 | $72K |
| D0150 | Comprehensive oral evaluation - new or established patient | 4.8% | 1,756 | 1,589 | $64K |
| D1120 | Dental cleaning, childProphylaxis - child | 4.5% | 2,639 | 2,482 | $60K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 4.2% | 1,849 | 1,801 | $56K |
| D1110 | Prophylaxis - adult | 2.3% | 740 | 713 | $31K |
10 more codes
| D0330 | Panoramic radiographic image | 2.1% | 860 | $28K |
| D9999 | Unspecified adjunctive procedure, by report | 1.7% | 693 | $22K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 1.3% | 763 | $18K |
| D0220 | Intraoral - periapical first radiographic image | 1.1% | 1,989 | $14K |
| D0274 | Bitewings - four radiographic images | <1% | 625 | $8K |
| D0272 | Bitewings - two radiographic images | <1% | 881 | $8K |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 3,626 | $7K |
| D1354 | <1% | 1,022 | $4K | |
| D7140 | Extraction, erupted tooth or exposed root | <1% | 56 | $3K |
| D0140 | Limited oral evaluation - problem focused | <1% | 88 | $2K |
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 officialPROBST, TRAVIS (OWNER/DENTIST)
| Provider | Location | Paid |
|---|---|---|
| Bonney Lake Dental LLC | Bonney Lake, WA | $4.81M |
| Fairwood Dental LLC | Renton, WA | $1.20M |
| Lake Meridian Dental LLC | Kent, WA | $435K |
| Puyallup Dental, LLC | Puyallup, WA | $84K |
| North Lakewood Dental PLCC | Lakewood, WA | $30K |
| Port Orchard Dental LLC | Port Orchard, WA | $7K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.