Clinic
South Park Family Dental Care PA
South Park Family Dental Care PA was paid $1.44M by Medicaid between Sep 2018 and Dec 2024, across 24 billing codes. Its largest line is D2392, Resin-based composite - two surfaces, posterior, primary or permanent — 17% of everything it billed.
33Billing provider infoSOUTH PARK FAMILY DENTAL CARE PA
SAN ANTONIO, TX 78224
SAN ANTONIO, TX 78224
33aNPI1467586768assigned 03/16/2007
33bProvider typeDental Clinic/Center
28Total paid$1.44M
24GClaims61,040
24DCodes billed24
24AFirst – last monthSep 2018 – Dec 2024
Compared with peers
Next to other Dental Clinic/Center providers in Texas
Rank by total paid#32 of 255
Median peer was paid$110K
This provider vs. median13×
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 | |
|---|---|---|---|
| 2018 | 73 | $1K | |
| 2019 | 13 | $0.00 | |
| 2020 | 2,527 | $63K | |
| 2021 | 15,318 | $347K | |
| 2022 | 14,199 | $353K | |
| 2023 | 17,986 | $417K | |
| 2024incomplete | 10,924 | $257K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 17% | 3,136 | 1,343 | $244K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 12% | 6,675 | 6,304 | $169K |
| D1110 | Prophylaxis - adult | 11% | 3,425 | 3,221 | $156K |
| D1120 | Dental cleaning, childProphylaxis - child | 8.0% | 3,581 | 3,418 | $115K |
| D0145 | Oral evaluation for a patient under three years of age | 7.0% | 838 | 803 | $100K |
| D0274 | Bitewings - four radiographic images | 6.8% | 3,321 | 3,110 | $98K |
| D1208 | Topical application of fluoride, excluding varnish | 6.3% | 7,008 | 6,642 | $90K |
| D0220 | Intraoral - periapical first radiographic image | 5.5% | 7,484 | 6,909 | $80K |
| D0230 | Intraoral - periapical each additional radiographic image | 5.0% | 7,364 | 6,729 | $72K |
| D0272 | Bitewings - two radiographic images | 4.6% | 3,159 | 3,007 | $66K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 4.5% | 1,020 | 569 | $64K |
| D1351 | Sealant - per tooth | 3.1% | 1,909 | 348 | $45K |
12 more codes
| D7240 | Removal of impacted tooth - completely bony | 2.8% | 153 | $41K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 2.6% | 1,660 | $38K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 1.2% | 216 | $18K |
| D0150 | Comprehensive oral evaluation - new or established patient | 1.0% | 565 | $14K |
| D0210 | Intraoral - complete series of radiographic images | <1% | 167 | $10K |
| D9248 | <1% | 71 | $7K | |
| D7230 | <1% | 38 | $5K | |
| D2930 | Prefabricated stainless steel crown - primary tooth | <1% | 41 | $2K |
| D1206 | Topical application of fluoride varnish | <1% | 142 | $2K |
| D0140 | Limited oral evaluation - problem focused | <1% | 90 | $1K |
| D0330 | Panoramic radiographic image | <1% | 23 | $223.24 |
| D0603 | 0% | 8,954 | $0.00 |
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 officialIZADDOUST, SHIVA (PRESIDENT)
| Provider | Location | Paid |
|---|---|---|
| Hildebrand Family Dental Care P.A. | San Antonio, TX | $82K |
| Shiva Izaddoust D.D.S. P.A. | San Antonio, TX | $37K |
| SP Administration | San Antonio, TX | $0.00 |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.