PINE DENTAL PC

NPI: 1245081736 · FITCHBURG, MA 01420 · Dental Clinic/Center · NPI assigned 04/01/2024

$16K

Total Medicaid Paid

444

Total Claims

394

Beneficiaries

Codes Billed

2024-08

First Month

2024-11

Last Month

Provider Details

Authorized Official	KIM, DONG (OWNER)
NPI Enumeration Date	04/01/2024

Other providers sharing the same authorized official: KIM, DONG

Provider	City	State	Total Paid
DR. DONGWON KIM PC	TAUNTON	MA	$1.53M
DR. DONGWON KIM PC	MATTAPAN	MA	$1.22M
QUABBIN VALLEY DENTAL PC	ATHOL	MA	$1.01M
SHOE CITY FAMILY DENTAL PC	HAVERHILL	MA	$138K
ROCKPORT FAMILY DENTAL PC	ROCKPORT	MA	$92K
SALEM FAMILY DENTAL CARE, P.C.	SALEM	MA	$83K
DONG S KIM DMD, PC	LUTHERVILLE	MD	$67K
LEE AND KIM DENTAL CORPORATION	ARTESIA	CA	$10K
DONG S. KIM, M.D., INC	MORENO VALLEY	CA	$1K

Year	Claims	Total Paid
2024	444	$16K

Code	Description	Claims	Beneficiaries	Total Paid
D0150	Comprehensive oral evaluation - new or established patient	99	93	$4K
D1110	Prophylaxis - adult	72	67	$4K
D0210	Intraoral - complete series of radiographic images	30	30	$2K
D0274	Bitewings - four radiographic images	42	38	$1K
D0220	Intraoral - periapical first radiographic image	87	72	$1K
D0230	Intraoral - periapical each additional radiographic image	71	53	$908.00
D1208	Topical application of fluoride, excluding varnish	31	29	$899.00
D0140	Limited oral evaluation - problem focused	12	12	$528.00