SOUTHRIDGE PEDIATRIC DENTISTRY
NPI: 1225249683
· SOUTH JORDAN, UT 84095
· Dentist
· NPI assigned 05/25/2007
$147K
Total Medicaid Paid
Provider Details
| Authorized Official | ROTH, DAVID (OWNER) |
| NPI Enumeration Date | 05/25/2007 |
Related Entities
Other providers sharing the same authorized official: ROTH, DAVID
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
1,354 |
$55K |
| 2022 |
2,115 |
$88K |
| 2023 |
94 |
$4K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
931 |
931 |
$106K |
| D0272 |
Bitewings - two radiographic images |
614 |
611 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
125 |
61 |
$7K |
| D2140 |
|
22 |
12 |
$3K |
| D1120 |
Prophylaxis - child |
874 |
871 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$1K |
| D1206 |
Topical application of fluoride varnish |
893 |
891 |
$1K |
| D0274 |
Bitewings - four radiographic images |
76 |
76 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$0.00 |