Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
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SMILE CENTER OF KNIGHTSVILLE

NPI: 1558543249 · SUMMERVILLE, SC 29483 · General Practice Dentistry · NPI assigned 12/04/2007

$973.60
Total Medicaid Paid
28
Total Claims
28
Beneficiaries
2
Codes Billed
2018-11
First Month
2023-03
Last Month

Provider Details

Authorized OfficialGOURDINE, JEANINE (OWNER/DENTIST)
NPI Enumeration Date12/04/2007

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 16 $368.00
2023 12 $605.60

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D1110 Prophylaxis - adult 12 12 $605.60
D0120 Periodic oral evaluation - established patient 16 16 $368.00