Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › AZ › MESA › FIESTA KIDTASTIC, LLC

FIESTA KIDTASTIC, LLC

NPI: 1215281688 · MESA, AZ 85202 · Pediatric Dentist · NPI assigned 11/06/2012

$21K
Total Medicaid Paid
1,284
Total Claims
1,152
Beneficiaries
6
Codes Billed
2018-02
First Month
2019-10
Last Month

Provider Details

Authorized OfficialJOHNSON, JAIME (CONTROLLER)
NPI Enumeration Date11/06/2012

Related Entities

Other providers sharing the same authorized official: JOHNSON, JAIME

ProviderCityStateTotal Paid
SUN VALLEY PEDIATRIC DENTISTRY, PLLC AVONDALE AZ $267K
HIGLEY VILLAGE KIDTASTIC, LLC GILBERT AZ $67K
SANTAN KIDTASTIC LLC SAN TAN VALLEY AZ $6K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 272 $5K
2019 1,012 $16K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D1120 Prophylaxis - child 262 244 $8K
D1206 Topical application of fluoride varnish 280 265 $5K
D0220 Intraoral - periapical first radiographic image 273 246 $2K
D0120 Periodic oral evaluation - established patient 107 95 $2K
D0230 Intraoral - periapical each additional radiographic image 244 203 $2K
D0272 Bitewings - two radiographic images 118 99 $2K