Dental
Davis-Wallace, Dedra
Davis-Wallace, Dedra was paid $3.60M by Medicaid between Sep 2019 and Dec 2024, across 28 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 15% of everything it billed.
33Billing provider infoDAVIS-WALLACE, DEDRA
EAU CLAIRE, WI 54701
EAU CLAIRE, WI 54701
33aNPI1518057934assigned 10/14/2006
33bProvider typePediatric Dentist
28Total paid$3.60M
24GClaims138,654
24DCodes billed28
24AFirst – last monthSep 2019 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Wisconsin
Rank by total paid#5 of 61
Median peer was paid$85K
This provider vs. median42×
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 | |
|---|---|---|---|
| 2019 | 6,801 | $149K | |
| 2020 | 22,085 | $420K | |
| 2021 | 28,895 | $556K | |
| 2022 | 28,206 | $866K | |
| 2023 | 29,188 | $830K | |
| 2024incomplete | 23,479 | $778K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 15% | 5,183 | 1,864 | $531K |
| D1351 | Sealant - per tooth | 9.6% | 17,325 | 3,667 | $344K |
| D1120 | Dental cleaning, childProphylaxis - child | 9.0% | 13,070 | 12,450 | $324K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 7.9% | 5,481 | 3,135 | $284K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 7.3% | 13,918 | 13,325 | $262K |
| D0240 | 7.1% | 18,120 | 9,809 | $255K | |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 6.9% | 5,402 | 4,947 | $249K |
| D1206 | Topical application of fluoride varnish | 5.4% | 12,389 | 11,866 | $195K |
| D1110 | Prophylaxis - adult | 4.5% | 5,045 | 4,812 | $161K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 4.5% | 2,368 | 1,503 | $161K |
| D9248 | 3.8% | 1,242 | 1,149 | $135K | |
| D0210 | Intraoral - complete series of radiographic images | 3.6% | 2,581 | 2,461 | $130K |
16 more codes
| D7140 | Extraction, erupted tooth or exposed root | 2.9% | 2,191 | $105K |
| D0274 | Bitewings - four radiographic images | 2.7% | 4,776 | $96K |
| D0150 | Comprehensive oral evaluation - new or established patient | 2.5% | 4,257 | $91K |
| D0272 | Bitewings - two radiographic images | 2.1% | 4,717 | $75K |
| D1208 | Topical application of fluoride, excluding varnish | 1.6% | 4,759 | $57K |
| D0140 | Limited oral evaluation - problem focused | 1.4% | 1,927 | $49K |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 4,999 | $35K |
| D0220 | Intraoral - periapical first radiographic image | <1% | 3,227 | $28K |
| D4355 | <1% | 249 | $24K | |
| D1510 | <1% | 51 | $2K | |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | <1% | 16 | $1K |
| D2330 | <1% | 16 | $925.60 | |
| D9110 | <1% | 31 | $604.00 | |
| D1999 | 0% | 4,485 | $0.00 | |
| D3120 | 0% | 759 | $0.00 | |
| D3110 | 0% | 70 | $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.