OUT OF THIS WORLD DENTISTRY PC
NPI: 1558760959
· DRAPER, UT 84020
· Pediatric Dentist
· NPI assigned 08/21/2014
$225K
Total Medicaid Paid
Provider Details
| Authorized Official | STARK, DANNIELLE (OFFICE MANAGER) |
| NPI Enumeration Date | 08/21/2014 |
Related Entities
Other providers sharing the same authorized official: STARK, DANNIELLE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
280 |
$8K |
| 2019 |
739 |
$21K |
| 2020 |
497 |
$19K |
| 2021 |
1,751 |
$49K |
| 2022 |
2,332 |
$60K |
| 2023 |
1,608 |
$39K |
| 2024 |
1,155 |
$29K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,820 |
1,803 |
$162K |
| D1120 |
Prophylaxis - child |
1,704 |
1,696 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,846 |
1,835 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,023 |
1,010 |
$8K |
| D0272 |
Bitewings - two radiographic images |
756 |
751 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,008 |
874 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
53 |
26 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
15 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
85 |
85 |
$1K |
| D1110 |
Prophylaxis - adult |
28 |
28 |
$0.00 |