Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › IA › DAVENPORT › JERSEY RIDGE DENTAL ASSOCIATES

JERSEY RIDGE DENTAL ASSOCIATES

NPI: 1194892521 · DAVENPORT, IA 52807 · General Practice Dentistry · NPI assigned 11/29/2006

$23K
Total Medicaid Paid
926
Total Claims
909
Beneficiaries
4
Codes Billed
2018-01
First Month
2023-04
Last Month

Provider Details

Authorized OfficialSAMUELSON, DAVID (PARTNER)
NPI Enumeration Date11/29/2006

Related Entities

Other providers sharing the same authorized official: SAMUELSON, DAVID

ProviderCityStateTotal Paid
LOWDEN DENTAL ASSOCIATES LOWDEN IA $870.81

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 192 $5K
2019 149 $4K
2020 120 $3K
2021 177 $4K
2022 158 $4K
2023 130 $3K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D1110 Prophylaxis - adult 360 357 $13K
D0120 Periodic oral evaluation - established patient 531 525 $9K
D1120 Prophylaxis - child 17 13 $432.83
D1206 Topical application of fluoride varnish 18 14 $264.60