Clinic
Ancient Mariner, LLC
Ancient Mariner, LLC was paid $348K by Medicaid between Jan 2018 and Jul 2018, across 23 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 15% of everything it billed.
33Billing provider infoANCIENT MARINER, LLC
COLUMBIA, SC 29209
COLUMBIA, SC 29209
33aNPI1225456247assigned 04/07/2014
33bProvider typeDental Clinic/Center
28Total paid$348K
24GClaims7,896
24DCodes billed23
24AFirst – last monthJan 2018 – Jul 2018
Compared with peers
Next to other Dental Clinic/Center providers in South Carolina
Rank by total paid#29 of 68
Median peer was paid$121K
This provider vs. median2.9×
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 | 7,896 | $348K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 15% | 415 | 162 | $51K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 12% | 428 | 245 | $40K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 8.2% | 357 | 145 | $29K |
| D7140 | Extraction, erupted tooth or exposed root | 6.7% | 281 | 146 | $23K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 6.6% | 302 | 193 | $23K |
| D1120 | Dental cleaning, childProphylaxis - child | 6.3% | 630 | 630 | $22K |
| D1110 | Prophylaxis - adult | 5.8% | 411 | 411 | $20K |
| D9248 | 5.4% | 290 | 271 | $19K | |
| D0150 | Comprehensive oral evaluation - new or established patient | 4.6% | 402 | 402 | $16K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 4.6% | 705 | 705 | $16K |
| D1206 | Topical application of fluoride varnish | 4.3% | 919 | 919 | $15K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 3.9% | 421 | 396 | $13K |
11 more codes
| D0274 | Bitewings - four radiographic images | 3.3% | 427 | $12K |
| D0140 | Limited oral evaluation - problem focused | 3.1% | 279 | $11K |
| D0272 | Bitewings - two radiographic images | 2.8% | 523 | $10K |
| D1351 | Sealant - per tooth | 2.3% | 265 | $8K |
| D0220 | Intraoral - periapical first radiographic image | 1.8% | 486 | $6K |
| D0330 | Panoramic radiographic image | 1.5% | 102 | $5K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | <1% | 18 | $2K |
| D0210 | Intraoral - complete series of radiographic images | <1% | 43 | $2K |
| D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | <1% | 14 | $2K |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 41 | $1K |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 137 | $1K |
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 officialPATTERSON, TONIA (OFFICE ADMINISTRATOR)