Clinic
Shadow Creek Pediatric Dentistry, LLC
Shadow Creek Pediatric Dentistry, LLC was paid $822K by Medicaid between Jul 2020 and Dec 2024, across 25 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 27% of everything it billed.
33Billing provider infoSHADOW CREEK PEDIATRIC DENTISTRY, LLC
WAUKEE, IA 50263
WAUKEE, IA 50263
33aNPI1538794516assigned 03/10/2020
33bProvider typeDental Clinic/Center
28Total paid$822K
24GClaims28,326
24DCodes billed25
24AFirst – last monthJul 2020 – Dec 2024
Compared with peers
Next to other Dental Clinic/Center providers in Iowa
Rank by total paid#8 of 61
Median peer was paid$33K
This provider vs. median25×
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 | 3,336 | $85K | |
| 2021 | 8,964 | $245K | |
| 2022 | 5,107 | $153K | |
| 2023 | 5,836 | $180K | |
| 2024incomplete | 5,083 | $159K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 27% | 2,213 | 950 | $224K |
| D1351 | Sealant - per tooth | 20% | 7,882 | 1,490 | $165K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 8.7% | 1,031 | 525 | $72K |
| D1120 | Dental cleaning, childProphylaxis - child | 7.3% | 2,250 | 2,223 | $60K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 5.3% | 1,960 | 1,768 | $44K |
| D1206 | Topical application of fluoride varnish | 4.7% | 2,454 | 2,423 | $38K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 4.1% | 590 | 356 | $34K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 4.1% | 1,519 | 1,511 | $34K |
| D7140 | Extraction, erupted tooth or exposed root | 3.8% | 646 | 362 | $31K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 2.8% | 459 | 274 | $23K |
| D0150 | Comprehensive oral evaluation - new or established patient | 2.3% | 874 | 845 | $19K |
| D9310 | 2.1% | 657 | 650 | $17K |
13 more codes
| D0272 | Bitewings - two radiographic images | 1.8% | 1,239 | $15K |
| D0330 | Panoramic radiographic image | 1.6% | 665 | $13K |
| D0210 | Intraoral - complete series of radiographic images | 1.4% | 217 | $11K |
| D0220 | Intraoral - periapical first radiographic image | <1% | 789 | $7K |
| D0240 | <1% | 405 | $6K | |
| D1510 | <1% | 42 | $4K | |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 435 | $4K |
| D1354 | <1% | 210 | $608.60 | |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 30 | $602.66 |
| D0170 | <1% | 14 | $358.26 | |
| D1999 | 0% | 1,624 | $0.00 | |
| D0603 | 0% | 109 | $0.00 | |
| D0601 | 0% | 12 | $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 officialHAMMOND, NANCY (OWNER)