SDPMWC, PLLC

NPI: 1538739610 · MIDWEST CITY, OK 73110 · Dental Clinic/Center · NPI assigned 06/30/2021

$13K

Total Medicaid Paid

696

Total Claims

646

Beneficiaries

Codes Billed

2022-03

First Month

2022-12

Last Month

Provider Details

Authorized Official	YATES, MIKE (CFO)
NPI Enumeration Date	06/30/2021

Other providers sharing the same authorized official: YATES, MIKE

Provider	City	State	Total Paid
SUMMER DENTAL SHAWNEE PLLC	SHAWNEE	OK	$2.58M
SUMMER DENTAL MACARTHUR PLLC	OKLAHOMA CITY	OK	$784K
COTTONWOOD DENTAL KELLOGG, P.A.	WICHITA	KS	$292K
BAXTER SPRINGS FAMILY DENTISTRY PA	BAXTER SPRINGS	KS	$237K
RIO DENTAL, P.A.	WICHITA	KS	$111K
TULSA PROSTH PLLC	TULSA	OK	$998.56

Year	Claims	Total Paid
2022	696	$13K

Code	Description	Claims	Beneficiaries	Total Paid
D1120	Prophylaxis - child	135	135	$4K
D1206	Topical application of fluoride varnish	173	173	$3K
D0120	Periodic oral evaluation - established patient	117	117	$2K
D0220	Intraoral - periapical first radiographic image	110	110	$2K
D0230	Intraoral - periapical each additional radiographic image	126	76	$937.26
D0140	Limited oral evaluation - problem focused	18	18	$549.00
D0150	Comprehensive oral evaluation - new or established patient	17	17	$518.50