Dental
Summerville Pediatric Dentistry
Summerville Pediatric Dentistry was paid $2.50M by Medicaid between Jan 2018 and Dec 2024, across 20 billing codes. Its largest line is D1120, dental cleaning, child — 16% of everything it billed.
33Billing provider infoSUMMERVILLE PEDIATRIC DENTISTRY
SUMMERVILLE, SC 29483
SUMMERVILLE, SC 29483
33aNPI1275764672assigned 08/03/2009
33bProvider typePediatric Dentist
28Total paid$2.50M
24GClaims81,787
24DCodes billed20
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in South Carolina
Rank by total paid#29 of 86
Median peer was paid$1.24M
This provider vs. median2.0×
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 | 8,379 | $254K | |
| 2019 | 9,823 | $300K | |
| 2020 | 9,986 | $317K | |
| 2021 | 13,235 | $406K | |
| 2022 | 14,227 | $429K | |
| 2023 | 13,135 | $377K | |
| 2024incomplete | 13,002 | $416K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 16% | 11,438 | 11,438 | $390K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 13% | 14,466 | 14,466 | $332K |
| D1110 | Prophylaxis - adult | 13% | 6,588 | 6,588 | $325K |
| D1206 | Topical application of fluoride varnish | 11% | 17,411 | 17,411 | $281K |
| D0272 | Bitewings - two radiographic images | 6.6% | 8,888 | 8,888 | $164K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 5.7% | 1,484 | 960 | $142K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 5.4% | 1,762 | 1,220 | $135K |
| D7140 | Extraction, erupted tooth or exposed root | 5.1% | 1,476 | 984 | $127K |
| D0274 | Bitewings - four radiographic images | 4.9% | 4,439 | 4,439 | $122K |
| D0330 | Panoramic radiographic image | 4.6% | 2,365 | 2,365 | $115K |
| D0150 | Comprehensive oral evaluation - new or established patient | 3.4% | 2,159 | 2,159 | $85K |
| D1351 | Sealant - per tooth | 3.3% | 2,812 | 734 | $82K |
8 more codes
| D0145 | Oral evaluation for a patient under three years of age | 2.6% | 1,435 | $65K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 2.5% | 2,077 | $63K |
| D0140 | Limited oral evaluation - problem focused | 1.7% | 1,151 | $42K |
| D0220 | Intraoral - periapical first radiographic image | <1% | 1,047 | $13K |
| D1354 | <1% | 496 | $7K | |
| D2930 | Prefabricated stainless steel crown - primary tooth | <1% | 40 | $5K |
| D0240 | <1% | 185 | $3K | |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 68 | $659.44 |
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 officialBAKER, DOROTHY (OWNER)