Managed care
Main Street Dental of Salt Lake City
Main Street Dental of Salt Lake City was paid $78K by Medicaid between Feb 2021 and Oct 2024, across 7 billing codes. Its largest line is D7210, Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth — 49% of everything it billed.
33Billing provider infoMAIN STREET DENTAL OF SALT LAKE CITY
SALT LAKE CITY, UT 84115
SALT LAKE CITY, UT 84115
33aNPI1245607068assigned 08/27/2015
33bProvider typePoint of Service
28Total paid$78K
24GClaims1,671
24DCodes billed7
24AFirst – last monthFeb 2021 – Oct 2024
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 | 380 | $16K | |
| 2022 | 786 | $38K | |
| 2023 | 337 | $18K | |
| 2024incomplete | 168 | $6K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | 49% | 580 | 233 | $38K |
| D0140 | Limited oral evaluation - problem focused | 33% | 455 | 419 | $26K |
| D0220 | Intraoral - periapical first radiographic image | 9.7% | 468 | 431 | $8K |
| D0150 | Comprehensive oral evaluation - new or established patient | 6.8% | 49 | 47 | $5K |
| D0274 | Bitewings - four radiographic images | 1.1% | 87 | 83 | $870.03 |
| D7922 | <1% | 17 | 12 | $380.00 | |
| D1110 | Prophylaxis - adult | <1% | 15 | 13 | $105.08 |
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 officialWILSON, JENNIFER (MANAGER/OWNER)
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| The Wayside House, INC | Saint Louis Park, MN | $7.90M |
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| 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 |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.