Dental
Fiesta Kidtastic, LLC
Fiesta Kidtastic, LLC was paid $21K by Medicaid between Feb 2018 and Oct 2019, across 6 billing codes. Its largest line is D1120, dental cleaning, child — 41% of everything it billed.
33Billing provider infoFIESTA KIDTASTIC, LLC
MESA, AZ 85202
MESA, AZ 85202
33aNPI1215281688assigned 11/06/2012
33bProvider typePediatric Dentist
28Total paid$21K
24GClaims1,284
24DCodes billed6
24AFirst – last monthFeb 2018 – Oct 2019
Compared with peers
Next to other Pediatric Dentist providers in Arizona
Rank by total paid#116 of 223
Median peer was paid$24K
This provider vs. median0.9×
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 | |
|---|---|---|---|
| 2018 | 272 | $5K | |
| 2019 | 1,012 | $16K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 41% | 262 | 244 | $8K |
| D1206 | Topical application of fluoride varnish | 22% | 280 | 265 | $5K |
| D0220 | Intraoral - periapical first radiographic image | 11% | 273 | 246 | $2K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 11% | 107 | 95 | $2K |
| D0230 | Intraoral - periapical each additional radiographic image | 8.6% | 244 | 203 | $2K |
| D0272 | Bitewings - two radiographic images | 7.2% | 118 | 99 | $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 officialJOHNSON, JAIME (CONTROLLER)
| Provider | Location | Paid |
|---|---|---|
| Sun Valley Pediatric Dentistry, PLLC | Avondale, AZ | $267K |
| Higley Village Kidtastic, LLC | Gilbert, AZ | $67K |
| Santan Kidtastic LLC | San Tan Valley, AZ | $6K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.