Clinic
Winona Pediatric Dentistry LLC
Winona Pediatric Dentistry LLC was paid $4K by Medicaid between Jan 2018 and May 2018, across 8 billing codes. Its largest line is D1206, Topical application of fluoride varnish — 36% of everything it billed.
33Billing provider infoWINONA PEDIATRIC DENTISTRY LLC
WINONA, MN 55987
WINONA, MN 55987
33aNPI1538525373assigned 01/09/2016
33bProvider typeDental Clinic/Center
28Total paid$4K
24GClaims1,815
24DCodes billed8
24AFirst – last monthJan 2018 – May 2018
Compared with peers
Next to other Dental Clinic/Center providers in Minnesota
Rank by total paid#115 of 148
Median peer was paid$70K
This provider vs. median0.1×
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 | 1,815 | $4K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1206 | Topical application of fluoride varnish | 36% | 463 | 455 | $1K |
| D1120 | Dental cleaning, childProphylaxis - child | 35% | 365 | 363 | $1K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 24% | 375 | 374 | $947.20 |
| D0272 | Bitewings - two radiographic images | 5.1% | 221 | 221 | $199.85 |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 0% | 84 | 61 | $0.00 |
| D0150 | Comprehensive oral evaluation - new or established patient | 0% | 49 | 48 | $0.00 |
| D1351 | Sealant - per tooth | 0% | 199 | 64 | $0.00 |
| D1110 | Prophylaxis - adult | 0% | 59 | 59 | $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 officialHANKS, JONATHAN (OWNER)
| Provider | Location | Paid |
|---|---|---|
| LA Crosse Pediatric Dentistry LLC | La Crosse, WI | $1.02M |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.