Dental
Indianola Pediatric Dentistry
Indianola Pediatric Dentistry was paid $265K by Medicaid between Jun 2020 and Jun 2021, across 20 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 40% of everything it billed.
33Billing provider infoINDIANOLA PEDIATRIC DENTISTRY
INDIANOLA, IA 50125
INDIANOLA, IA 50125
33aNPI1538719075assigned 09/17/2019
33bProvider typePediatric Dentist
28Total paid$265K
24GClaims10,115
24DCodes billed20
24AFirst – last monthJun 2020 – Jun 2021
Compared with peers
Next to other Pediatric Dentist providers in Iowa
Rank by total paid#31 of 58
Median peer was paid$284K
This provider vs. median0.9×
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 | 5,251 | $127K | |
| 2021 | 4,864 | $138K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 40% | 1,185 | 268 | $106K |
| D1120 | Dental cleaning, childProphylaxis - child | 8.6% | 1,088 | 993 | $23K |
| D1206 | Topical application of fluoride varnish | 5.8% | 1,269 | 1,155 | $15K |
| D7140 | Extraction, erupted tooth or exposed root | 5.6% | 310 | 150 | $15K |
| D1351 | Sealant - per tooth | 5.6% | 836 | 214 | $15K |
| D0150 | Comprehensive oral evaluation - new or established patient | 5.0% | 704 | 619 | $13K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 4.6% | 270 | 88 | $12K |
| D0272 | Bitewings - two radiographic images | 3.8% | 765 | 675 | $10K |
| D0220 | Intraoral - periapical first radiographic image | 3.5% | 1,102 | 964 | $9K |
| D0230 | Intraoral - periapical each additional radiographic image | 3.0% | 1,056 | 877 | $8K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 2.9% | 395 | 336 | $8K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 2.2% | 354 | 350 | $6K |
8 more codes
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 2.0% | 108 | $5K |
| D0330 | Panoramic radiographic image | 1.9% | 140 | $5K |
| D9310 | 1.7% | 218 | $5K | |
| D1110 | Prophylaxis - adult | 1.1% | 94 | $3K |
| D9420 | <1% | 64 | $2K | |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 92 | $2K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | <1% | 21 | $1K |
| D0274 | Bitewings - four radiographic images | <1% | 44 | $994.09 |
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 officialFOX, SANDRA (OWNER)