Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › MN › ST CLOUD › PETERSON DENTAL ASSOCIATES, P.A.

PETERSON DENTAL ASSOCIATES, P.A.

NPI: 1396856100 · ST CLOUD, MN 56301 · Dental Hygienist · NPI assigned 08/31/2006

$31K
Total Medicaid Paid
985
Total Claims
981
Beneficiaries
4
Codes Billed
2018-01
First Month
2024-03
Last Month

Provider Details

Authorized OfficialPETERSON, RUSSELL (PRESIDENT OF CORP)
NPI Enumeration Date08/31/2006

Related Entities

Other providers sharing the same authorized official: PETERSON, RUSSELL

ProviderCityStateTotal Paid
DREAMLIFE DESTINY LLC MAPLE GROVE MN $986K
RANDOLPH MEDICAL ASSOCIATES, PC ROANOKE AL $69K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 143 $46.04
2019 115 $3K
2020 88 $3K
2021 128 $4K
2022 232 $10K
2023 235 $10K
2024 44 $2K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D1110 Prophylaxis - adult 370 370 $17K
D0120 Periodic oral evaluation - established patient 563 560 $13K
D1206 Topical application of fluoride varnish 39 38 $811.58
D0274 Bitewings - four radiographic images 13 13 $564.10