PEORIA ST. DENTAL AND ORTHODONTICS PLLC

NPI: 1417526294 · AURORA, CO 80011 · General Practice Dentistry · NPI assigned 06/24/2021

Billing Flags · Automated signals — not evidence of fraud

Entity Proliferation

Authorized official KOUYOUMDJIAN, RAFFY controls 19+ related entities in our dataset. Read more

$949K

Total Medicaid Paid

17,862

Total Claims

14,871

Beneficiaries

Codes Billed

2021-11

First Month

2024-12

Last Month

Provider Details

Authorized Official	KOUYOUMDJIAN, RAFFY (OWNER)
NPI Enumeration Date	06/24/2021

Other providers sharing the same authorized official: KOUYOUMDJIAN, RAFFY

Provider	City	State	Total Paid
RODEO WESLACO DENTAL & ORTHODONTICS	WESLACO	TX	$14.00M
RODEO DENTAL PHARR PLLC	PHARR	TX	$10.70M
RODEO DENTAL SAN BENITO, PLLC	SAN BENITO	TX	$10.54M
PASADENA DENTAL & ORTHODONTICS PLLC	SOUTH HOUSTON	TX	$8.93M
RODEO DENTAL SOUTHMOST PLLC	BROWNSVILLE	TX	$8.91M
FM KATY DENTAL AND ORTHODONTICS, PLLC	FORT WORTH	TX	$8.87M
REAL SMILES	FORT WORTH	TX	$7.68M
ELSA DENTAL AND ORTHODONTICS, PLLC	FORT WORTH	TX	$7.40M
RODEO LAREDO DENTAL & ORTHODONTICS, PLLC	LAREDO	TX	$6.12M
RODEO DENTAL CENTRAL PLLC	BROWNSVILLE	TX	$6.08M
RUBEN TORRES DENTAL, PLLC	BROWNSVILLE	TX	$5.21M
WACO DENTAL AND ORTHODONTICS, PLLC	WACO	TX	$2.19M
CYPRESS POINT DENTAL AND ORTHODONTICS, PLLC	HOUSTON	TX	$1.48M
KIRKWOOD DENTAL AND ORTHODONTICS, PLLC	STAFFORD	TX	$1.18M
MIDLAND DENTAL AND ORTHODONTICS, PLLC	MIDLAND	TX	$463K
CASA GRANDE DENTAL AND ORTHODONTICS LLC	CASA GRANDE	AZ	$199K
PHOENIX DENTAL AND ORTHODONTICS, PLLC	PHOENIX	AZ	$86K
TUCSON DENTAL AND ORTHODONTICS	TUCSON	AZ	$45K
290 CROSSING DENTAL AND ORTHODONTICS PLLC	HOUSTON	TX	$16K

Code	Description	Claims	Beneficiaries	Total Paid
D0350		2,275	1,118	$218K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	1,336	543	$179K
D2391	Resin-based composite - one surface, posterior, primary or permanent	769	361	$81K
D1120	Prophylaxis - child	1,493	1,489	$64K
D0150	Comprehensive oral evaluation - new or established patient	1,482	1,476	$63K
D0230	Intraoral - periapical each additional radiographic image	1,778	1,771	$44K
D1110	Prophylaxis - adult	696	692	$38K
D0210	Intraoral - complete series of radiographic images	683	676	$36K
D0120	Periodic oral evaluation - established patient	1,075	1,071	$30K
D0220	Intraoral - periapical first radiographic image	2,001	1,983	$26K
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	149	79	$24K
D4341		69	27	$18K
D0274	Bitewings - four radiographic images	577	575	$18K
D1208	Topical application of fluoride, excluding varnish	1,165	1,154	$16K
D1351	Sealant - per tooth	296	90	$15K
D1206	Topical application of fluoride varnish	622	621	$14K
D1354		248	81	$14K
D8660		80	80	$12K
D0272	Bitewings - two radiographic images	491	487	$11K
D2930	Prefabricated stainless steel crown - primary tooth	79	14	$10K
D0330	Panoramic radiographic image	136	136	$7K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	167	157	$5K
D0140	Limited oral evaluation - problem focused	81	80	$3K
D0145	Oral evaluation for a patient under three years of age	85	85	$3K
D0160		17	13	$1K
D0340		12	12	$713.16