Medicaid Provider Spending

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

COUNTRYSIDE MALL DENTAL PA

NPI: 1568023067 · CLEARWATER, FL 33761 · General Practice Dentistry · NPI assigned 06/25/2019

Billing Flags · Automated signals — not evidence of fraud
Entity Proliferation

Authorized official KRASNOV, ROSTISLAV controls 17+ related entities in our dataset. Read more

$155K
Total Medicaid Paid
13,646
Total Claims
13,109
Beneficiaries
20
Codes Billed
2020-01
First Month
2024-04
Last Month

Provider Details

Authorized OfficialKRASNOV, ROSTISLAV (OWNER)
NPI Enumeration Date06/25/2019

Related Entities

Other providers sharing the same authorized official: KRASNOV, ROSTISLAV

ProviderCityStateTotal Paid
WESTLAND MALL DENTAL, PA HIALEAH FL $923K
CROSS COUNTY MALL DENTAL, PA WEST PALM BEACH FL $906K
BROWARD MALL DENTAL, PA PLANTATION FL $620K
MIAMI INTERNATIONAL MALL DENTAL, PA MIAMI FL $528K
ALTAMONTE MALL DENTAL PA ALTAMONTE SPRINGS FL $395K
BRANDON MALL DENTAL P.A. BRANDON FL $283K
EDISON MALL DENTAL P.A FORT MYERS FL $255K
BOYNTON BEACH MALL DENTAL PA BOYNTON BEACH FL $174K
SAWGRASS MILLS MALL DENTAL, PA SUNRISE FL $169K
REGENCY SQUARE MALL DENTAL JACKSONVILLE FL $163K
PEMBROKE LAKES MALL DENTAL PA PEMBROKE PINES FL $62K
LAUDERHILL MALL DENTAL, PA LAUDERHILL FL $31K
TYRONE SQUARE MALL DENTAL P.A ST PETERSBURG FL $14K
WILLOWBROOK MALL DENTAL HOUSTON TX $10K
METROTECH DENTAL ASSOCIATES PLLC BROOKLYN NY $8K
WHEATON MALL DENTAL LLP WHEATON MD $3K
PG PLAZE DENTAL HYATTSVILLE MD $3K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2020 301 $4K
2021 2,196 $20K
2022 4,846 $50K
2023 5,260 $69K
2024 1,043 $12K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D0150 Comprehensive oral evaluation - new or established patient 1,804 1,789 $87K
D0120 Periodic oral evaluation - established patient 342 339 $14K
D1110 Prophylaxis - adult 660 654 $14K
D2391 Resin-based composite - one surface, posterior, primary or permanent 392 217 $11K
D0140 Limited oral evaluation - problem focused 493 450 $9K
D2392 Resin-based composite - two surfaces, posterior, primary or permanent 138 101 $5K
D7210 Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth 79 25 $3K
D0210 Intraoral - complete series of radiographic images 51 51 $3K
D0330 Panoramic radiographic image 1,883 1,869 $2K
D1208 Topical application of fluoride, excluding varnish 876 859 $2K
D9310 24 24 $1K
D1330 1,754 1,635 $1K
D0272 Bitewings - two radiographic images 1,572 1,558 $1K
D4355 51 51 $985.92
D0220 Intraoral - periapical first radiographic image 1,743 1,727 $828.36
D9999 Unspecified adjunctive procedure, by report 14 14 $280.00
D4346 27 27 $111.61
D0230 Intraoral - periapical each additional radiographic image 1,646 1,630 $107.80
D1120 Prophylaxis - child 33 33 $36.00
D4921 64 56 $0.00