Clinic
White Swan Dental Clnic
White Swan Dental Clnic was paid $238K by Medicaid between Jan 2018 and Mar 2020, across 10 billing codes. Its largest line is T1015, a visit at a community health center or clinic (one all-in rate) — 95% of everything it billed.
33Billing provider infoWHITE SWAN DENTAL CLNIC
WHITE SWAN, WA 98952
WHITE SWAN, WA 98952
33aNPI1245378389assigned 02/01/2007
33bProvider typeDental Clinic/Center
28Total paid$238K
24GClaims2,307
24DCodes billed10
24AFirst – last monthJan 2018 – Mar 2020
Compared with peers
Next to other Dental Clinic/Center providers in Washington
Rank by total paid#92 of 143
Median peer was paid$573K
This provider vs. median0.4×
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 | 2,091 | $197K | |
| 2019 | 126 | $22K | |
| 2020 | 90 | $20K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| T1015 | A visit at a community health center or clinic (one all-in rate)Clinic visit/encounter, all-inclusive | 95% | 816 | 597 | $226K |
| D1206 | Topical application of fluoride varnish | 2.8% | 705 | 526 | $7K |
| D0140 | Limited oral evaluation - problem focused | 1.2% | 193 | 162 | $3K |
| D0220 | Intraoral - periapical first radiographic image | <1% | 186 | 171 | $1K |
| D2150 | Silver amalgam - two surfaces, primary or permanent | <1% | 26 | 12 | $853.56 |
| D0150 | Comprehensive oral evaluation - new or established patient | <1% | 24 | 24 | $432.64 |
| D7140 | Extraction, erupted tooth or exposed root | <1% | 14 | 12 | $335.39 |
| D1351 | Sealant - per tooth | <1% | 114 | 16 | $153.86 |
| D1330 | 0% | 127 | 121 | $0.00 | |
| D0191 | 0% | 102 | 100 | $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 officialSAMPSON, JAY (CEO)
Parent organizationWHITE SWAN DENTAL CLINIC
| Provider | Location | Paid |
|---|---|---|
| Yakama Indian Health Center | Toppenish, WA | $34.03M |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.