Dental
Space City Pediatric Dentistry
Space City Pediatric Dentistry was paid $4.11M by Medicaid between Sep 2018 and Dec 2024, across 29 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 14% of everything it billed.
33Billing provider infoSPACE CITY PEDIATRIC DENTISTRY
FRIENDSWOOD, TX 77546
FRIENDSWOOD, TX 77546
33aNPI1487811659assigned 05/16/2008
33bProvider typePediatric Dentist
28Total paid$4.11M
24GClaims135,387
24DCodes billed29
24AFirst – last monthSep 2018 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Texas
Rank by total paid#42 of 693
Median peer was paid$252K
This provider vs. median16×
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 | 114 | $2K | |
| 2019 | 413 | $6K | |
| 2020 | 3,793 | $119K | |
| 2021 | 35,989 | $1.16M | |
| 2022 | 36,438 | $1.12M | |
| 2023 | 34,674 | $1.04M | |
| 2024incomplete | 23,966 | $669K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 14% | 4,340 | 1,620 | $592K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 13% | 20,225 | 19,469 | $550K |
| D1120 | Dental cleaning, childProphylaxis - child | 13% | 15,452 | 14,836 | $531K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 8.6% | 3,970 | 2,282 | $353K |
| D9248 | 7.9% | 2,991 | 2,762 | $323K | |
| D1110 | Prophylaxis - adult | 7.6% | 6,087 | 5,859 | $312K |
| D1206 | Topical application of fluoride varnish | 7.0% | 20,663 | 19,882 | $286K |
| D0145 | Oral evaluation for a patient under three years of age | 6.3% | 1,913 | 1,855 | $257K |
| D0272 | Bitewings - two radiographic images | 4.3% | 8,055 | 7,705 | $176K |
| D0274 | Bitewings - four radiographic images | 2.9% | 3,653 | 3,526 | $119K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 2.7% | 4,628 | 4,221 | $112K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 2.1% | 1,206 | 893 | $86K |
17 more codes
| D1351 | Sealant - per tooth | 1.8% | 3,057 | $74K |
| D0150 | Comprehensive oral evaluation - new or established patient | 1.4% | 1,832 | $56K |
| D0220 | Intraoral - periapical first radiographic image | 1.4% | 5,051 | $56K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 1.1% | 614 | $45K |
| D7140 | Extraction, erupted tooth or exposed root | 1.1% | 1,111 | $44K |
| D0330 | Panoramic radiographic image | <1% | 701 | $40K |
| D0140 | Limited oral evaluation - problem focused | <1% | 1,806 | $30K |
| D0210 | Intraoral - complete series of radiographic images | <1% | 462 | $29K |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 2,591 | $23K |
| D1208 | Topical application of fluoride, excluding varnish | <1% | 442 | $6K |
| D7111 | <1% | 387 | $4K | |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | <1% | 40 | $2K |
| D3120 | <1% | 13 | $57.34 | |
| D0603 | 0% | 11,800 | $0.00 | |
| D0601 | 0% | 2,167 | $0.00 | |
| D0602 | 0% | 10,108 | $0.00 | |
| D1999 | 0% | 22 | $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 officialIBARRA, BRET (OWNER)