SALEM FAMILY DENTAL CARE, P.C.

NPI: 1336413632 · SALEM, MA 01970 · General Practice Dentistry · NPI assigned 03/05/2012

$83K

Total Medicaid Paid

2,398

Total Claims

2,347

Beneficiaries

Codes Billed

2018-01

First Month

2019-07

Last Month

Provider Details

Authorized Official	KIM, DONG (PRESIDENT)
NPI Enumeration Date	03/05/2012

Other providers sharing the same authorized official: KIM, DONG

Provider	City	State	Total Paid
DR. DONGWON KIM PC	TAUNTON	MA	$1.53M
DR. DONGWON KIM PC	MATTAPAN	MA	$1.22M
QUABBIN VALLEY DENTAL PC	ATHOL	MA	$1.01M
SHOE CITY FAMILY DENTAL PC	HAVERHILL	MA	$138K
ROCKPORT FAMILY DENTAL PC	ROCKPORT	MA	$92K
DONG S KIM DMD, PC	LUTHERVILLE	MD	$67K
PINE DENTAL PC	FITCHBURG	MA	$16K
LEE AND KIM DENTAL CORPORATION	ARTESIA	CA	$10K
DONG S. KIM, M.D., INC	MORENO VALLEY	CA	$1K

Year	Claims	Total Paid
2018	1,485	$51K
2019	913	$32K

Code	Description	Claims	Beneficiaries	Total Paid
D1110	Prophylaxis - adult	680	671	$34K
D0120	Periodic oral evaluation - established patient	558	550	$12K
D0274	Bitewings - four radiographic images	392	386	$11K
D0330	Panoramic radiographic image	173	173	$8K
D0150	Comprehensive oral evaluation - new or established patient	119	119	$5K
D0220	Intraoral - periapical first radiographic image	284	272	$4K
D0140	Limited oral evaluation - problem focused	75	75	$3K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	43	27	$3K
D1208	Topical application of fluoride, excluding varnish	62	62	$2K
D1120	Prophylaxis - child	12	12	$612.00