Dental
Pediatric Dental Group, LLC
Pediatric Dental Group, LLC was paid $12.84M by Medicaid between Oct 2021 and Dec 2024, across 43 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 14% of everything it billed.
33Billing provider infoPEDIATRIC DENTAL GROUP, LLC
TULSA, OK 74120
TULSA, OK 74120
33aNPI1609018548assigned 03/24/2009
33bProvider typePediatric Dentist
28Total paid$12.84M
24GClaims305,012
24DCodes billed43
24AFirst – last monthOct 2021 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Oklahoma
Rank by total paid#3 of 32
Median peer was paid$804K
This provider vs. median16×
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 | |
|---|---|---|---|
| 2021 | 16,303 | $652K | |
| 2022 | 94,461 | $3.76M | |
| 2023 | 105,183 | $4.59M | |
| 2024incomplete | 89,065 | $3.84M |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 14% | 15,121 | 4,953 | $1.80M |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 12% | 13,599 | 7,978 | $1.52M |
| D9248 | 8.8% | 8,472 | 7,807 | $1.13M | |
| D1120 | Dental cleaning, childProphylaxis - child | 7.5% | 31,655 | 30,573 | $957K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 5.9% | 35,707 | 34,588 | $755K |
| D1206 | Topical application of fluoride varnish | 5.8% | 43,123 | 41,704 | $744K |
| D1351 | Sealant - per tooth | 4.3% | 22,937 | 7,533 | $553K |
| D1110 | Prophylaxis - adult | 4.3% | 12,118 | 11,775 | $547K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 3.7% | 3,145 | 2,317 | $479K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 3.7% | 5,181 | 2,368 | $469K |
| D2934 | 3.1% | 2,611 | 988 | $393K | |
| D7140 | Extraction, erupted tooth or exposed root | 3.0% | 5,879 | 3,290 | $389K |
31 more codes
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 2.8% | 5,995 | $359K |
| D0330 | Panoramic radiographic image | 2.5% | 6,646 | $319K |
| D0272 | Bitewings - two radiographic images | 2.1% | 14,647 | $266K |
| 00170 | Anesthesia for intraoral procedures, including biopsy | 2.0% | 790 | $253K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 1.8% | 8,296 | $225K |
| D9223 | Deep sedation/general anesthesia - each subsequent 15 minute increment | 1.6% | 651 | $204K |
| D0274 | Bitewings - four radiographic images | 1.6% | 6,729 | $203K |
| D0220 | Intraoral - periapical first radiographic image | 1.2% | 10,385 | $157K |
| D0150 | Comprehensive oral evaluation - new or established patient | 1.1% | 4,849 | $146K |
| D0140 | Limited oral evaluation - problem focused | <1% | 3,583 | $108K |
| D0603 | <1% | 11,306 | $103K | |
| D0601 | <1% | 10,313 | $94K | |
| D1510 | <1% | 702 | $84K | |
| D8080 | Comprehensive orthodontic treatment of the adolescent dentition | <1% | 71 | $78K |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 2,371 | $72K |
| D7240 | Removal of impacted tooth - completely bony | <1% | 319 | $70K |
| D7111 | <1% | 1,023 | $62K | |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 7,473 | $57K |
| D9222 | <1% | 648 | $51K | |
| D0602 | <1% | 5,246 | $48K | |
| D9610 | <1% | 1,488 | $45K | |
| D3120 | <1% | 749 | $23K | |
| D2394 | <1% | 119 | $20K | |
| D9310 | <1% | 404 | $20K | |
| D2330 | <1% | 287 | $17K | |
| D3230 | <1% | 67 | $7K | |
| D0350 | <1% | 180 | $5K | |
| D2332 | <1% | 38 | $4K | |
| D0340 | <1% | 63 | $4K | |
| D7962 | <1% | 12 | $2K | |
| D0270 | <1% | 14 | $213.36 |
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 officialKEITHLINE, CHARLES (MANAGING MEMBER)
| Provider | Location | Paid |
|---|---|---|
| Ob Dental, LLC | Tulsa, OK | $2.48M |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.