Clinic
Pediatric Dentistry of Casa Grande
Pediatric Dentistry of Casa Grande was paid $557K by Medicaid between Sep 2021 and Nov 2024, across 17 billing codes. Its largest line is D1120, dental cleaning, child — 17% of everything it billed.
33Billing provider infoPEDIATRIC DENTISTRY OF CASA GRANDE
CASA GRANDE, AZ 85122
CASA GRANDE, AZ 85122
33aNPI1558995951assigned 02/25/2020
33bProvider typeDental Clinic/Center
28Total paid$557K
24GClaims16,503
24DCodes billed17
24AFirst – last monthSep 2021 – Nov 2024
Compared with peers
Next to other Dental Clinic/Center providers in Arizona
Rank by total paid#8 of 70
Median peer was paid$7K
This provider vs. median80×
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 | |
|---|---|---|---|
| 2021 | 733 | $20K | |
| 2022 | 5,302 | $175K | |
| 2023 | 6,190 | $225K | |
| 2024incomplete | 4,278 | $137K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 17% | 2,277 | 2,248 | $95K |
| D0230 | Intraoral - periapical each additional radiographic image | 14% | 2,817 | 2,773 | $79K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 13% | 768 | 428 | $71K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 12% | 2,360 | 2,348 | $68K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 8.2% | 330 | 115 | $46K |
| D0220 | Intraoral - periapical first radiographic image | 7.8% | 3,008 | 2,957 | $43K |
| D1208 | Topical application of fluoride, excluding varnish | 6.2% | 1,703 | 1,695 | $35K |
| D0272 | Bitewings - two radiographic images | 4.9% | 1,188 | 1,180 | $27K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 4.6% | 283 | 86 | $25K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 3.7% | 753 | 674 | $21K |
| D7140 | Extraction, erupted tooth or exposed root | 2.6% | 166 | 79 | $14K |
| D0274 | Bitewings - four radiographic images | 2.5% | 425 | 420 | $14K |
5 more codes
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 officialMONTANEZ, MARIO (PEDIATRIC DENTIST/OWNER)