Clinic
Nicoma Park Dental PLLC
Nicoma Park Dental PLLC was paid $330K by Medicaid between Feb 2020 and Nov 2024, across 15 billing codes. Its largest line is D7210, Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth — 26% of everything it billed.
33Billing provider infoNICOMA PARK DENTAL PLLC
OKLAHOMA CITY, OK 73141
OKLAHOMA CITY, OK 73141
33aNPI1518452952assigned 06/27/2018
33bProvider typeDental Clinic/Center
28Total paid$330K
24GClaims8,157
24DCodes billed15
24AFirst – last monthFeb 2020 – Nov 2024
Compared with peers
Next to other Dental Clinic/Center providers in Oklahoma
Rank by total paid#33 of 112
Median peer was paid$86K
This provider vs. median3.8×
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 | |
|---|---|---|---|
| 2020 | 257 | $5K | |
| 2021 | 1,340 | $50K | |
| 2022 | 2,102 | $107K | |
| 2023 | 2,349 | $92K | |
| 2024incomplete | 2,109 | $75K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | 26% | 698 | 165 | $86K |
| D1110 | Prophylaxis - adult | 13% | 936 | 895 | $42K |
| D0330 | Panoramic radiographic image | 11% | 758 | 725 | $36K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 10% | 306 | 186 | $34K |
| D0274 | Bitewings - four radiographic images | 7.6% | 825 | 800 | $25K |
| D0150 | Comprehensive oral evaluation - new or established patient | 7.2% | 809 | 761 | $24K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 6.0% | 960 | 925 | $20K |
| D0140 | Limited oral evaluation - problem focused | 5.3% | 599 | 573 | $17K |
| D1120 | Dental cleaning, childProphylaxis - child | 4.1% | 456 | 435 | $14K |
| D1206 | Topical application of fluoride varnish | 3.6% | 779 | 756 | $12K |
| D0220 | Intraoral - periapical first radiographic image | 3.5% | 787 | 750 | $12K |
| D7140 | Extraction, erupted tooth or exposed root | 1.3% | 77 | 26 | $4K |
3 more codes
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 officialWALLACE, JASON (OWNER)
| Provider | Location | Paid |
|---|---|---|
| Brownsville Community Health Clinic Corporation | Brownsville, TX | $7.24M |
| Brownsville Community Health Clinic Corporation | Brownsville, TX | $1.81M |
| Brownsville Community Health Clinic Corporation | Brownsville, TX | $266K |
| J Wallace LLC | Williamstown, KY | $81K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.