Dental
Riverside Pediatric Dentistry LLC
Riverside Pediatric Dentistry LLC was paid $723K by Medicaid between Jul 2022 and Dec 2024, across 21 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 28% of everything it billed.
33Billing provider infoRIVERSIDE PEDIATRIC DENTISTRY LLC
FLORENCE, SC 29501
FLORENCE, SC 29501
33aNPI1598400475assigned 05/04/2022
33bProvider typePediatric Dentist
28Total paid$723K
24GClaims16,040
24DCodes billed21
24AFirst – last monthJul 2022 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in South Carolina
Rank by total paid#51 of 86
Median peer was paid$1.24M
This provider vs. median0.6×
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 | |
|---|---|---|---|
| 2022 | 1,375 | $46K | |
| 2023 | 5,343 | $177K | |
| 2024incomplete | 9,322 | $500K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 28% | 1,409 | 409 | $199K |
| D1120 | Dental cleaning, childProphylaxis - child | 8.7% | 1,756 | 1,756 | $63K |
| D7140 | Extraction, erupted tooth or exposed root | 7.4% | 376 | 178 | $54K |
| D2934 | 7.4% | 364 | 94 | $54K | |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 6.6% | 541 | 215 | $48K |
| D9420 | 5.1% | 409 | 409 | $37K | |
| D0230 | Intraoral - periapical each additional radiographic image | 4.5% | 2,823 | 1,435 | $33K |
| D9248 | 4.5% | 384 | 372 | $32K | |
| D1206 | Topical application of fluoride varnish | 4.4% | 1,855 | 1,855 | $32K |
| D0140 | Limited oral evaluation - problem focused | 4.2% | 782 | 779 | $31K |
| D0220 | Intraoral - periapical first radiographic image | 4.2% | 2,247 | 2,239 | $30K |
| D0150 | Comprehensive oral evaluation - new or established patient | 4.0% | 679 | 679 | $29K |
9 more codes
| D0120 | Dental checkup, returning patient | 2.2% | 625 | $16K |
| D0145 | Oral evaluation for a patient under three years of age | 2.1% | 230 | $15K |
| D9920 | 1.9% | 263 | $14K | |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 1.9% | 403 | $13K |
| D0272 | Bitewings - two radiographic images | 1.5% | 568 | $11K |
| D1351 | Sealant - per tooth | <1% | 233 | $7K |
| D0330 | Panoramic radiographic image | <1% | 55 | $3K |
| D9310 | <1% | 26 | $2K | |
| D1110 | Prophylaxis - adult | <1% | 12 | $604.80 |
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 officialBOURGOYNE, KATHY (OFFICE MANAGER)