Clark, Kellan

Clark, Kellan was paid $89K by Medicaid between Sep 2020 and May 2021, across 14 billing codes. Its largest line is D0120, dental checkup, returning patient — 54% of everything it billed.

33Billing provider infoCLARK, KELLAN
WEST VALLEY CITY, UT 84120

33aNPI1366050296assigned 07/16/2020

33bProvider typeDentist

28Total paid$89K

24GClaims3,268

24DCodes billed14

24AFirst – last monthSep 2020 – May 2021

Compared with peers

Next to other Dentist providers in Utah

Rank by total paid#47 of 136

Median peer was paid$35K

This provider vs. median2.5×

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
2020	1,375	$36K
2021	1,893	$53K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	54%	434	427	$48K
D0150	Comprehensive oral evaluation - new or established patient	18%	130	129	$16K
D0140	Limited oral evaluation - problem focused	10%	166	165	$9K
D2150	Silver amalgam - two surfaces, primary or permanent	6.3%	94	50	$6K
D0220	Intraoral - periapical first radiographic image	4.0%	576	559	$4K
D2140		2.7%	48	29	$2K
D7140	Extraction, erupted tooth or exposed root	1.7%	33	13	$2K
D1206	Topical application of fluoride varnish	1.1%	417	412	$981.71
D1120	Dental cleaning, childProphylaxis - child	<1%	382	378	$817.09
D0330	Panoramic radiographic image	<1%	57	55	$519.39
D0272	Bitewings - two radiographic images	<1%	134	134	$294.28
D0230	Intraoral - periapical each additional radiographic image	<1%	503	446	$243.71

2 more codes

D0274	Bitewings - four radiographic images	<1%	234	$141.29
D1110	Prophylaxis - adult	<1%	60	$121.09

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.