Dental Family Practice

Dental Family Practice was paid $3K by Medicaid between Mar 2018 and Nov 2018, across 4 billing codes. Its largest line is D1206, Topical application of fluoride varnish — 47% of everything it billed.

33Billing provider infoDENTAL FAMILY PRACTICE
LAKE RIDGE, VA 22192

33aNPI1558483305assigned 04/04/2007

33bProvider typePeriodontist

28Total paid$3K

24GClaims143

24DCodes billed4

24AFirst – last monthMar 2018 – Nov 2018

Compared with peers

Next to other Periodontist providers in Virginia

Rank by total paid#6 of 8

Median peer was paid$14K

This provider vs. median0.2×

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	143	$3K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1206	Topical application of fluoride varnish	47%	77	77	$2K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	25%	42	42	$846.30
D1110	Prophylaxis - adult	17%	12	12	$566.28
D1120	Dental cleaning, childProphylaxis - child	12%	12	12	$402.24

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 officialMOSTOFI, MINA (DENTIST)