DENTAL DEPOT OF ARLINGTON PLLC

NPI: 1386390680 · ARLINGTON, TX 76017 · General Practice Dentistry · NPI assigned 02/24/2022

Billing Flags · Automated signals — not evidence of fraud

Entity Proliferation

Authorized official ZISSA, GAYLON controls 13+ related entities in our dataset. Read more

$31K

Total Medicaid Paid

2,437

Total Claims

1,887

Beneficiaries

Codes Billed

2023-03

First Month

2024-12

Last Month

Provider Details

Authorized Official	ZISSA, GAYLON (DIRECTOR OF PROVIDER RELATIONS)
NPI Enumeration Date	02/24/2022

Other providers sharing the same authorized official: ZISSA, GAYLON

Provider	City	State	Total Paid
DENTAL DEPOT SOUTH	OKLAHOMA CITY	OK	$3.40M
DENTAL DEPOT ORTHODONTICS CENTRAL OKC PLLC	OKLAHOMA CITY	OK	$3.31M
DENTAL DEPOT ORTHODONTICS SOUTH PLLC	OKLAHOMA CITY	OK	$2.53M
DENTAL DEPOT OF I-44 & GARNETT, PLLC	TULSA	OK	$1.34M
DENTAL DEPOT ORTHODONTICS NORTH OKC PLLC	OKLAHOMA CITY	OK	$1.22M
DENTAL DEPOT ORTHODONTICS YUKON PLLC	YUKON	OK	$1.04M
DENTAL DEPOT OF 164TH & PORTLAND PLLC	OKLAHOMA CITY	OK	$546K
DENTAL DEPOT OF DEL CITY, PLLC	DEL CITY	OK	$438K
DENTAL DEPOT ORTHODONTICS TECUMSEH, PLLC	NORMAN	OK	$107K
DENTAL DEPOT ORTHODONTICS DEL CITY, PLLC	DEL CITY	OK	$21K
DENTAL DEPOT OF BLUE SPRINGS PLLC	BLUE SPRINGS	MO	$21K
DENTAL DEPOT OF INDEPENDENCE, PLLC	INDEPENDENCE	MO	$6K
DENTAL DEPOT OF MUSTANG, PLLC	OKLAHOMA CITY	OK	$5K

Year	Claims	Total Paid
2023	1,211	$15K
2024	1,226	$16K

Code	Description	Claims	Beneficiaries	Total Paid
D1120	Prophylaxis - child	161	151	$5K
D0150	Comprehensive oral evaluation - new or established patient	177	156	$5K
D1208	Topical application of fluoride, excluding varnish	309	296	$4K
D0230	Intraoral - periapical each additional radiographic image	612	290	$3K
D0330	Panoramic radiographic image	153	134	$3K
D1351	Sealant - per tooth	118	13	$2K
D0274	Bitewings - four radiographic images	208	192	$2K
D0210	Intraoral - complete series of radiographic images	30	30	$2K
D0120	Periodic oral evaluation - established patient	71	67	$2K
D0220	Intraoral - periapical first radiographic image	342	310	$2K
D1110	Prophylaxis - adult	30	28	$1K
D0602		139	136	$0.00
D0603		87	84	$0.00