My Local Colorado Dental Practice, LLC

My Local Colorado Dental Practice, LLC was paid $31K by Medicaid between Dec 2019 and Jul 2021, across 6 billing codes. Its largest line is D1110, Prophylaxis - adult — 37% of everything it billed.

33Billing provider infoMY LOCAL COLORADO DENTAL PRACTICE, LLC
ARVADA, CO 80003

33aNPI1417501180assigned 07/30/2019

33bProvider typeGeneral Practice Dentistry

28Total paid$31K

24GClaims655

24DCodes billed6

24AFirst – last monthDec 2019 – Jul 2021

Compared with peers

Next to other General Practice Dentistry providers in Colorado

Rank by total paid#298 of 521

Median peer was paid$53K

This provider vs. median0.6×

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
2019	47	$2K
2020	436	$24K
2021	172	$6K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1110	Prophylaxis - adult	37%	277	277	$11K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	37%	78	37	$11K
D0150	Comprehensive oral evaluation - new or established patient	12%	99	99	$4K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	11%	149	149	$3K
D0274	Bitewings - four radiographic images	2.2%	24	24	$668.50
D0220	Intraoral - periapical first radiographic image	1.1%	28	28	$350.20

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 officialKOSTELAC, GREGORY (CREDENTIALING SPECIALIST)

Parent organizationMY LOCAL COLORADO DENTAL PRACTICE, LLC