SHAWD NEIGHBORHOOD DENTAL CLINIC BERESFORD P.C.
NPI: 1467763995
· BERESFORD, SD 57004
· General Practice Dentistry
· NPI assigned 06/30/2010
$249K
Total Medicaid Paid
Provider Details
| Authorized Official | OLSON, LYNN (HR MANAGER) |
| NPI Enumeration Date | 06/30/2010 |
Related Entities
Other providers sharing the same authorized official: OLSON, LYNN
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
729 |
$19K |
| 2019 |
989 |
$28K |
| 2020 |
709 |
$21K |
| 2021 |
1,590 |
$54K |
| 2022 |
1,776 |
$56K |
| 2023 |
1,420 |
$38K |
| 2024 |
916 |
$34K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,410 |
2,394 |
$64K |
| D1120 |
Prophylaxis - child |
1,666 |
1,657 |
$61K |
| D1206 |
Topical application of fluoride varnish |
2,363 |
2,350 |
$52K |
| D1110 |
Prophylaxis - adult |
625 |
615 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
174 |
105 |
$16K |
| D0272 |
Bitewings - two radiographic images |
467 |
467 |
$12K |
| D0274 |
Bitewings - four radiographic images |
229 |
229 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
122 |
109 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
17 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$1K |
| D1351 |
Sealant - per tooth |
24 |
12 |
$0.00 |