Clinic
Countryside Pediatric Dentistry
Countryside Pediatric Dentistry was paid $18K by Medicaid between Oct 2024 and Dec 2024, across 10 billing codes. Its largest line is D0150, Comprehensive oral evaluation - new or established patient — 18% of everything it billed.
33Billing provider infoCOUNTRYSIDE PEDIATRIC DENTISTRY
YORK, NE 68467
YORK, NE 68467
33aNPI1336986447assigned 07/15/2024
33bProvider typeDental Clinic/Center
28Total paid$18K
24GClaims615
24DCodes billed10
24AFirst – last monthOct 2024 – Dec 2024
Compared with peers
Next to other Dental Clinic/Center providers in Nebraska
Rank by total paid#24 of 41
Median peer was paid$25K
This provider vs. median0.7×
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 | |
|---|---|---|---|
| 2024incomplete | 615 | $18K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0150 | Comprehensive oral evaluation - new or established patient | 18% | 109 | 109 | $3K |
| D1120 | Dental cleaning, childProphylaxis - child | 18% | 97 | 97 | $3K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 17% | 38 | 19 | $3K |
| D1206 | Topical application of fluoride varnish | 16% | 109 | 109 | $3K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 12% | 24 | 14 | $2K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 9.8% | 47 | 35 | $2K |
| D0272 | Bitewings - two radiographic images | 4.1% | 47 | 47 | $739.20 |
| D0230 | Intraoral - periapical each additional radiographic image | 2.3% | 81 | 29 | $418.50 |
| D0220 | Intraoral - periapical first radiographic image | 2.1% | 48 | 48 | $373.06 |
| D0274 | Bitewings - four radiographic images | 2.0% | 15 | 15 | $360.08 |
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 officialNEVILLE, BAILEY (OWNER, DENTIST)