Dental
Pediatric Dentistry LLC
Pediatric Dentistry LLC was paid $4.10M by Medicaid between Jan 2018 and Dec 2024, across 20 billing codes. Its largest line is D1206, Topical application of fluoride varnish — 16% of everything it billed.
33Billing provider infoPEDIATRIC DENTISTRY LLC
CHEYENNE, WY 82009
CHEYENNE, WY 82009
33aNPI1265848774assigned 07/03/2014
33bProvider typePediatric Dentist
28Total paid$4.10M
24GClaims129,366
24DCodes billed20
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Wyoming
Rank by total paid#2 of 16
Median peer was paid$454K
This provider vs. median9.0×
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 | 34,685 | $1.08M | |
| 2019 | 16,604 | $566K | |
| 2020 | 11,468 | $346K | |
| 2021 | 18,150 | $474K | |
| 2022 | 15,335 | $448K | |
| 2023 | 16,797 | $580K | |
| 2024incomplete | 16,327 | $608K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1206 | Topical application of fluoride varnish | 16% | 20,345 | 19,795 | $673K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 16% | 20,667 | 20,106 | $650K |
| D1120 | Dental cleaning, childProphylaxis - child | 14% | 17,180 | 16,744 | $582K |
| D1110 | Prophylaxis - adult | 8.6% | 7,238 | 6,966 | $353K |
| D1351 | Sealant - per tooth | 6.2% | 9,145 | 2,525 | $255K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 5.5% | 1,765 | 496 | $224K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 5.0% | 2,878 | 1,750 | $206K |
| D0230 | Intraoral - periapical each additional radiographic image | 5.0% | 14,290 | 12,763 | $205K |
| D0220 | Intraoral - periapical first radiographic image | 4.9% | 14,383 | 13,891 | $201K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 4.7% | 2,123 | 1,325 | $192K |
| D0272 | Bitewings - two radiographic images | 4.0% | 7,537 | 7,319 | $166K |
| D0150 | Comprehensive oral evaluation - new or established patient | 2.6% | 3,588 | 3,520 | $108K |
8 more codes
| D0274 | Bitewings - four radiographic images | 2.3% | 2,891 | $95K |
| D0330 | Panoramic radiographic image | 1.7% | 1,317 | $69K |
| D7140 | Extraction, erupted tooth or exposed root | 1.1% | 712 | $46K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | <1% | 1,491 | $37K |
| D9420 | <1% | 140 | $17K | |
| D0140 | Limited oral evaluation - problem focused | <1% | 401 | $12K |
| D1310 | <1% | 898 | $9K | |
| D1999 | <1% | 377 | $4K |
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 officialHENRY, MATTHEW (OWNER)