MARTINSVILLE PEDIATRIC DENTISTRY, L.L.C.

NPI: 1588035703 · MARTINSVILLE, IN 46151 · Pediatric Dentist · NPI assigned 10/14/2015

$5K

Total Medicaid Paid

1,306

Total Claims

1,186

Beneficiaries

Codes Billed

2018-01

First Month

2019-01

Last Month

Provider Details

Authorized Official	TAYLOR, KYLE (OWNER/PEDIATRIC DENTIST)
NPI Enumeration Date	10/14/2015

Other providers sharing the same authorized official: TAYLOR, KYLE

Provider	City	State	Total Paid
BLOOMINGTON PEDIATRIC DENTISTRY L.L.C.	BLOOMINGTON	IN	$3.10M
BEDFORD PEDIATRIC DENTISTRY, L.L.C.	BEDFORD	IN	$1.04M

Year	Claims	Total Paid
2018	1,224	$3K
2019	82	$2K

Code	Description	Claims	Beneficiaries	Total Paid
D1120	Prophylaxis - child	285	271	$2K
D1206	Topical application of fluoride varnish	375	356	$1K
D0120	Periodic oral evaluation - established patient	357	338	$1K
D1351	Sealant - per tooth	71	14	$352.20
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	107	96	$216.65
D0150	Comprehensive oral evaluation - new or established patient	33	33	$106.50
D0272	Bitewings - two radiographic images	61	61	$99.24
D1110	Prophylaxis - adult	17	17	$0.00