Dental
Southridge Pediatric Dentistry
Southridge Pediatric Dentistry was paid $147K by Medicaid between Jun 2021 and Feb 2023, across 9 billing codes. Its largest line is D0120, dental checkup, returning patient — 72% of everything it billed.
33Billing provider infoSOUTHRIDGE PEDIATRIC DENTISTRY
SOUTH JORDAN, UT 84095
SOUTH JORDAN, UT 84095
33aNPI1225249683assigned 05/25/2007
33bProvider typeDentist
28Total paid$147K
24GClaims3,563
24DCodes billed9
24AFirst – last monthJun 2021 – Feb 2023
Compared with peers
Next to other Dentist providers in Utah
Rank by total paid#37 of 136
Median peer was paid$35K
This provider vs. median4.2×
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 | |
|---|---|---|---|
| 2021 | 1,354 | $55K | |
| 2022 | 2,115 | $88K | |
| 2023 | 94 | $4K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 72% | 931 | 931 | $106K |
| D0272 | Bitewings - two radiographic images | 18% | 614 | 611 | $26K |
| D2150 | Silver amalgam - two surfaces, primary or permanent | 4.4% | 125 | 61 | $7K |
| D2140 | 2.0% | 22 | 12 | $3K | |
| D1120 | Dental cleaning, childProphylaxis - child | 1.8% | 874 | 871 | $3K |
| D0150 | Comprehensive oral evaluation - new or established patient | <1% | 16 | 16 | $1K |
| D1206 | Topical application of fluoride varnish | <1% | 893 | 891 | $1K |
| D0274 | Bitewings - four radiographic images | 0% | 76 | 76 | $0.00 |
| D1208 | Topical application of fluoride, excluding varnish | 0% | 12 | 12 | $0.00 |
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 officialROTH, DAVID (OWNER)
| Provider | Location | Paid |
|---|---|---|
| Board of Fire Commissioners of Copiague Fire Dist | Copiague, NY | $138K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.