SOUTHCENTRAL FOUNDATION
NPI: 1497202394
· KOKHANOK, AK 99606
· General Practice Dentistry
· NPI assigned 09/08/2016
Billing Flags
· Automated signals — not evidence of fraud
Entity Proliferation
Authorized official OLSON, RONALD controls 20+ related entities in our dataset. Read more
$230K
Total Medicaid Paid
Provider Details
| Authorized Official | OLSON, RONALD (EXECUTIVE VICE PRESIDENT FINANCE) |
| Parent Organization | SOUTHCENTRAL FOUNDATION |
| NPI Enumeration Date | 09/08/2016 |
Related Entities
Other providers sharing the same authorized official: OLSON, RONALD
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
433 |
$72K |
| 2019 |
256 |
$56K |
| 2020 |
130 |
$20K |
| 2021 |
146 |
$11K |
| 2022 |
170 |
$30K |
| 2023 |
131 |
$41K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
271 |
261 |
$132K |
| D1206 |
Topical application of fluoride varnish |
397 |
363 |
$42K |
| D1120 |
Prophylaxis - child |
207 |
198 |
$38K |
| D1351 |
Sealant - per tooth |
231 |
73 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
19 |
18 |
$5K |
| D1110 |
Prophylaxis - adult |
39 |
38 |
$3K |
| D0274 |
Bitewings - four radiographic images |
28 |
22 |
$1K |
| D0272 |
Bitewings - two radiographic images |
35 |
32 |
$653.00 |
| D0603 |
|
39 |
37 |
$0.00 |