PHOENIX WISDOM TEETH, LLC
NPI: 1255945366
· GLENDALE, AZ 85308
· Oral and Maxillofacial Surgery (Dentist)
· NPI assigned 09/04/2020
$893K
Total Medicaid Paid
Provider Details
| Authorized Official | ARNOLD, RYAN (MANAGING MEMBER) |
| NPI Enumeration Date | 09/04/2020 |
Related Entities
Other providers sharing the same authorized official: ARNOLD, RYAN
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
3,851 |
$192K |
| 2023 |
7,436 |
$387K |
| 2024 |
6,837 |
$314K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
3,523 |
1,493 |
$401K |
| D7230 |
|
1,543 |
895 |
$148K |
| D9243 |
|
2,697 |
1,837 |
$104K |
| D9239 |
|
2,016 |
1,981 |
$83K |
| D0330 |
Panoramic radiographic image |
4,243 |
4,192 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
2,852 |
2,803 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
733 |
369 |
$47K |
| D7220 |
|
39 |
26 |
$4K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
226 |
206 |
$2K |
| D9222 |
|
252 |
247 |
$382.45 |