Dental
Lake Wylie Pediatric Dentistry, LLC
Lake Wylie Pediatric Dentistry, LLC was paid $1.63M by Medicaid between Jan 2018 and Dec 2024, across 22 billing codes. Its largest line is D1120, dental cleaning, child — 16% of everything it billed.
33Billing provider infoLAKE WYLIE PEDIATRIC DENTISTRY, LLC
CLOVER, SC 29710
CLOVER, SC 29710
33aNPI1528428091assigned 02/26/2016
33bProvider typePediatric Dentist
28Total paid$1.63M
24GClaims42,383
24DCodes billed22
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in South Carolina
Rank by total paid#40 of 86
Median peer was paid$1.24M
This provider vs. median1.3×
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 | 6,662 | $356K | |
| 2019 | 7,853 | $326K | |
| 2020 | 5,990 | $212K | |
| 2021 | 5,863 | $211K | |
| 2022 | 6,226 | $226K | |
| 2023 | 5,314 | $154K | |
| 2024incomplete | 4,475 | $142K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 16% | 7,481 | 7,443 | $260K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 13% | 1,720 | 486 | $217K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 13% | 2,016 | 1,206 | $209K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 10% | 7,107 | 7,079 | $167K |
| D1206 | Topical application of fluoride varnish | 8.7% | 8,701 | 8,664 | $142K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 5.9% | 2,926 | 2,839 | $96K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 5.7% | 1,125 | 746 | $92K |
| D7140 | Extraction, erupted tooth or exposed root | 4.7% | 866 | 464 | $76K |
| D1110 | Prophylaxis - adult | 4.4% | 1,420 | 1,417 | $72K |
| D0272 | Bitewings - two radiographic images | 3.9% | 3,345 | 3,335 | $63K |
| D1351 | Sealant - per tooth | 2.9% | 1,617 | 594 | $48K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 2.7% | 533 | 220 | $43K |
10 more codes
| D0140 | Limited oral evaluation - problem focused | 2.3% | 958 | $37K |
| D0150 | Comprehensive oral evaluation - new or established patient | 2.2% | 885 | $36K |
| D0330 | Panoramic radiographic image | 1.5% | 495 | $25K |
| D0145 | Oral evaluation for a patient under three years of age | 1.0% | 427 | $17K |
| D9420 | <1% | 142 | $12K | |
| D0240 | <1% | 321 | $6K | |
| D0274 | Bitewings - four radiographic images | <1% | 189 | $5K |
| D1510 | <1% | 14 | $2K | |
| D0220 | Intraoral - periapical first radiographic image | <1% | 82 | $1K |
| D9310 | <1% | 13 | $819.00 |
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 officialCOLOSI, RYAN (MEMBER)