DENTAL DEPOT OF DEL CITY, PLLC

NPI: 1205512779 · DEL CITY, OK 73115 · Dentist · NPI assigned 06/27/2023

Billing Flags · Automated signals — not evidence of fraud

Entity Proliferation

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

$438K

Total Medicaid Paid

10,886

Total Claims

8,757

Beneficiaries

Codes Billed

2023-12

First Month

2024-12

Last Month

Provider Details

Authorized Official	ZISSA, GAYLON (DIRECTOR OF PROVIDER RELATIONS)
NPI Enumeration Date	06/27/2023

Other providers sharing the same authorized official: ZISSA, GAYLON

Provider	City	State	Total 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 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 BLUE SPRINGS PLLC	BLUE SPRINGS	MO	$21K
DENTAL DEPOT OF INDEPENDENCE, PLLC	INDEPENDENCE	MO	$6K
DENTAL DEPOT OF MUSTANG, PLLC	OKLAHOMA CITY	OK	$5K

Year	Claims	Total Paid
2023	86	$2K
2024	10,800	$436K

Code	Description	Claims	Beneficiaries	Total Paid
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth	768	245	$92K
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	522	277	$88K
D0330	Panoramic radiographic image	958	859	$47K
D0150	Comprehensive oral evaluation - new or established patient	1,096	973	$34K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	256	156	$32K
D0274	Bitewings - four radiographic images	963	909	$30K
D0220	Intraoral - periapical first radiographic image	1,790	1,589	$27K
D1110	Prophylaxis - adult	446	410	$21K
D1120	Prophylaxis - child	511	440	$15K
D1206	Topical application of fluoride varnish	814	728	$15K
D0230	Intraoral - periapical each additional radiographic image	1,883	1,383	$15K
D0120	Periodic oral evaluation - established patient	231	215	$5K
D7140	Extraction, erupted tooth or exposed root	63	29	$5K
D0140	Limited oral evaluation - problem focused	137	122	$4K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	102	96	$3K
D2394		12	12	$2K
D0601		221	221	$2K
D0602		51	51	$466.65
D0210	Intraoral - complete series of radiographic images	35	15	$428.09
D0603		27	27	$222.60