Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
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MAIN STREET DENTAL OF SALT LAKE CITY

NPI: 1245607068 · SALT LAKE CITY, UT 84115 · Point of Service · NPI assigned 08/27/2015

$78K
Total Medicaid Paid
1,671
Total Claims
1,238
Beneficiaries
7
Codes Billed
2021-02
First Month
2024-10
Last Month

Provider Details

Authorized OfficialWILSON, JENNIFER (MANAGER/OWNER)
NPI Enumeration Date08/27/2015

Related Entities

Other providers sharing the same authorized official: WILSON, JENNIFER

ProviderCityStateTotal Paid
THE WAYSIDE HOUSE, INC SAINT LOUIS PARK MN $7.90M
THE WAYSIDE HOUSE, INC. MINNEAPOLIS MN $3.00M
THE WAYSIDE HOUSE, INC. SAINT PAUL MN $1.43M
CENTER FOR SPEECH AND LANGUAGE PATHOLOGY, LLC HUNTSVILLE AL $1.15M
ONE SOURCE MEDICAL SOLUTIONS, INC. DALLAS TX $888K
COMPREHENSIVE COMMUNITY SUPPORTIVE SERVICES PLLC BURLINGTON NC $313K
HOPEWELL MENTAL HEALTH SERVICES, LLC DUBLIN OH $7K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2021 380 $16K
2022 786 $38K
2023 337 $18K
2024 168 $6K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth 580 233 $38K
D0140 Limited oral evaluation - problem focused 455 419 $26K
D0220 Intraoral - periapical first radiographic image 468 431 $8K
D0150 Comprehensive oral evaluation - new or established patient 49 47 $5K
D0274 Bitewings - four radiographic images 87 83 $870.03
D7922 17 12 $380.00
D1110 Prophylaxis - adult 15 13 $105.08