Three Fountains Family Dental INC

Three Fountains Family Dental INC was paid $196K by Medicaid between Jan 2018 and Nov 2024, across 10 billing codes. Its largest line is D1110, Prophylaxis - adult — 32% of everything it billed.

33Billing provider infoTHREE FOUNTAINS FAMILY DENTAL INC
WEST COLUMBIA, SC 29170

33aNPI1295805042assigned 11/09/2006

33bProvider typeGeneral Practice Dentistry

28Total paid$196K

24GClaims5,469

24DCodes billed10

24AFirst – last monthJan 2018 – Nov 2024

Compared with peers

Next to other General Practice Dentistry providers in South Carolina

Rank by total paid#128 of 331

Median peer was paid$75K

This provider vs. median2.6×

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	548	$23K
2019	619	$25K
2020	584	$21K
2021	1,260	$44K
2022	1,032	$38K
2023	964	$31K
2024incomplete	462	$15K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1110	Prophylaxis - adult	32%	1,287	1,287	$64K
D0330	Panoramic radiographic image	19%	772	772	$38K
D0140	Limited oral evaluation - problem focused	10%	561	560	$20K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	9.5%	834	834	$19K
D0274	Bitewings - four radiographic images	9.3%	666	666	$18K
D0150	Comprehensive oral evaluation - new or established patient	9.1%	458	458	$18K
D1206	Topical application of fluoride varnish	6.4%	764	764	$13K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	2.3%	51	24	$4K
D1120	Dental cleaning, childProphylaxis - child	1.1%	63	63	$2K
D0220	Intraoral - periapical first radiographic image	<1%	13	13	$153.96

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 officialSTOLTZ, PETER (DENTIST PRESIDENT)