Clinic
Wilderness Station Pediatric Dentistry
Wilderness Station Pediatric Dentistry was paid $135K by Medicaid between Jan 2018 and Nov 2019, across 17 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 43% of everything it billed.
33Billing provider infoWILDERNESS STATION PEDIATRIC DENTISTRY
LINCOLN, NE 68512
LINCOLN, NE 68512
33aNPI1568682052assigned 04/26/2007
33bProvider typeDental Clinic/Center
28Total paid$135K
24GClaims3,910
24DCodes billed17
24AFirst – last monthJan 2018 – Nov 2019
Compared with peers
Next to other Dental Clinic/Center providers in Nebraska
Rank by total paid#14 of 41
Median peer was paid$25K
This provider vs. median5.5×
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 | |
|---|---|---|---|
| 2018 | 2,761 | $111K | |
| 2019 | 1,149 | $25K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 43% | 515 | 121 | $58K |
| D1206 | Topical application of fluoride varnish | 13% | 864 | 806 | $17K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 9.8% | 617 | 617 | $13K |
| D1120 | Dental cleaning, childProphylaxis - child | 9.8% | 519 | 519 | $13K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 5.5% | 141 | 79 | $7K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 4.8% | 247 | 237 | $6K |
| D0272 | Bitewings - two radiographic images | 4.0% | 436 | 436 | $5K |
| D1351 | Sealant - per tooth | 2.7% | 152 | 52 | $4K |
| D2934 | 2.7% | 28 | 12 | $4K | |
| D7140 | Extraction, erupted tooth or exposed root | 1.5% | 33 | 14 | $2K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | <1% | 17 | 13 | $1K |
| D9420 | <1% | 15 | 15 | $1K |
5 more codes
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 130 | $565.00 |
| D0220 | Intraoral - periapical first radiographic image | <1% | 86 | $480.00 |
| D0240 | <1% | 71 | $476.00 | |
| D1208 | Topical application of fluoride, excluding varnish | <1% | 26 | $396.00 |
| D0150 | Comprehensive oral evaluation - new or established patient | <1% | 13 | $264.00 |
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 officialKILLEEN, MARTIN (DOCTOR)