Dental
Montoya Pediatric Dentistry LLC Dba San Tan Pediatric Dental
Montoya Pediatric Dentistry LLC Dba San Tan Pediatric Dental was paid $235K by Medicaid between Jan 2018 and Jun 2020, across 21 billing codes. Its largest line is D1120, dental cleaning, child — 16% of everything it billed.
33Billing provider infoMONTOYA PEDIATRIC DENTISTRY LLC DBA SAN TAN PEDIATRIC DENTAL
QUEEN CREEK, AZ 85243
QUEEN CREEK, AZ 85243
33aNPI1467607218assigned 11/20/2008
33bProvider typePediatric Dentist
28Total paid$235K
24GClaims25,879
24DCodes billed21
24AFirst – last monthJan 2018 – Jun 2020
Compared with peers
Next to other Pediatric Dentist providers in Arizona
Rank by total paid#52 of 223
Median peer was paid$24K
This provider vs. median10.0×
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 | 8,855 | $82K | |
| 2019 | 12,866 | $118K | |
| 2020 | 4,158 | $35K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 16% | 2,794 | 2,640 | $38K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 11% | 3,235 | 3,089 | $26K |
| D1206 | Topical application of fluoride varnish | 9.8% | 3,502 | 3,306 | $23K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 8.3% | 674 | 278 | $19K |
| D0274 | Bitewings - four radiographic images | 7.3% | 1,589 | 1,521 | $17K |
| D1110 | Prophylaxis - adult | 6.2% | 920 | 886 | $15K |
| D0272 | Bitewings - two radiographic images | 6.0% | 1,963 | 1,856 | $14K |
| D1351 | Sealant - per tooth | 5.5% | 1,256 | 287 | $13K |
| D0220 | Intraoral - periapical first radiographic image | 5.3% | 2,704 | 2,534 | $13K |
| D0150 | Comprehensive oral evaluation - new or established patient | 5.3% | 651 | 615 | $12K |
| D0230 | Intraoral - periapical each additional radiographic image | 4.8% | 2,794 | 2,343 | $11K |
| D0240 | 4.2% | 1,607 | 1,236 | $10K |
9 more codes
| D0330 | Panoramic radiographic image | 4.0% | 747 | $9K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 2.0% | 657 | $5K |
| D7140 | Extraction, erupted tooth or exposed root | 1.0% | 89 | $2K |
| D2930 | Prefabricated stainless steel crown - primary tooth | <1% | 36 | $2K |
| D1208 | Topical application of fluoride, excluding varnish | <1% | 297 | $2K |
| D0140 | Limited oral evaluation - problem focused | <1% | 141 | $2K |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 125 | $1K |
| D0210 | Intraoral - complete series of radiographic images | <1% | 75 | $547.36 |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | <1% | 23 | $318.98 |
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 officialMONTOYA, STEPHEN (OWNER/DENTIST)
| Provider | Location | Paid |
|---|---|---|
| Texas Super Smiles for Kids LLC | Plainview, TX | $735K |
| Fiesta Kids Dental LLC | Mesa, AZ | $49K |
| Frankford Dental Group | Lubbock, TX | $19K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.