Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › IN › INDIANAPOLIS › WEST 38TH DENTAL, LTD

WEST 38TH DENTAL, LTD

NPI: 1245649052 · INDIANAPOLIS, IN 46254 · Dentist · NPI assigned 08/06/2014

$4K
Total Medicaid Paid
126
Total Claims
106
Beneficiaries
4
Codes Billed
2019-03
First Month
2022-06
Last Month

Provider Details

Authorized OfficialKONG, SUNG (OWNER)
NPI Enumeration Date08/06/2014

Related Entities

Other providers sharing the same authorized official: KONG, SUNG

ProviderCityStateTotal Paid
BRIGHT SMILE DENTAL CARE FISHERS IN $14K
CENTER GROVE DENTAL, LLC GREENWOOD IN $157.69

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2019 21 $493.45
2021 63 $2K
2022 42 $1K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D0150 Comprehensive oral evaluation - new or established patient 68 56 $2K
D0210 Intraoral - complete series of radiographic images 17 12 $760.56
D0120 Periodic oral evaluation - established patient 28 26 $541.88
D1110 Prophylaxis - adult 13 12 $515.73