Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › MA › HAVERHILL › SHOE CITY FAMILY DENTAL PC

SHOE CITY FAMILY DENTAL PC

NPI: 1487267282 · HAVERHILL, MA 01830 · Dental Clinic/Center · NPI assigned 08/31/2020

$138K
Total Medicaid Paid
2,972
Total Claims
2,910
Beneficiaries
11
Codes Billed
2021-08
First Month
2024-12
Last Month

Provider Details

Authorized OfficialKIM, DONG (OWNER)
NPI Enumeration Date08/31/2020

Related Entities

Other providers sharing the same authorized official: KIM, DONG

ProviderCityStateTotal Paid
DR. DONGWON KIM PC TAUNTON MA $1.53M
DR. DONGWON KIM PC MATTAPAN MA $1.22M
QUABBIN VALLEY DENTAL PC ATHOL MA $1.01M
ROCKPORT FAMILY DENTAL PC ROCKPORT MA $92K
SALEM FAMILY DENTAL CARE, P.C. SALEM MA $83K
DONG S KIM DMD, PC LUTHERVILLE MD $67K
PINE DENTAL PC FITCHBURG MA $16K
LEE AND KIM DENTAL CORPORATION ARTESIA CA $10K
DONG S. KIM, M.D., INC MORENO VALLEY CA $1K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2021 50 $2K
2022 656 $28K
2023 990 $56K
2024 1,276 $52K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D1110 Prophylaxis - adult 806 793 $46K
D0274 Bitewings - four radiographic images 819 805 $24K
D2740 Crown - porcelain/ceramic 22 12 $16K
D0330 Panoramic radiographic image 274 268 $16K
D0150 Comprehensive oral evaluation - new or established patient 326 318 $14K
D0120 Periodic oral evaluation - established patient 478 472 $12K
D1208 Topical application of fluoride, excluding varnish 125 125 $4K
D2950 17 13 $3K
D1120 Prophylaxis - child 26 26 $1K
D0220 Intraoral - periapical first radiographic image 65 64 $967.00
D0140 Limited oral evaluation - problem focused 14 14 $442.00