SAN ANTONIO WISDOM TEETH, PLLC
NPI: 1568080497
· SAN ANTONIO, TX 78249
· Oral and Maxillofacial Surgery (Dentist)
· NPI assigned 07/07/2020
$516K
Total Medicaid Paid
Provider Details
| Authorized Official | ARNOLD, RYAN (ADMINISTRATOR) |
| NPI Enumeration Date | 07/07/2020 |
Related Entities
Other providers sharing the same authorized official: ARNOLD, RYAN
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2021 |
291 |
$21K |
| 2022 |
1,392 |
$139K |
| 2023 |
2,085 |
$213K |
| 2024 |
1,408 |
$143K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
1,506 |
474 |
$376K |
| D0330 |
Panoramic radiographic image |
1,416 |
1,379 |
$78K |
| D9222 |
|
499 |
468 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
928 |
888 |
$16K |
| D9610 |
|
503 |
472 |
$6K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
158 |
106 |
$6K |
| D9239 |
|
82 |
81 |
$4K |
| D9243 |
|
84 |
60 |
$3K |