4TH Avenue Dental, PA, Dba Oak Park Dental

4TH Avenue Dental, PA, Dba Oak Park Dental was paid $7K by Medicaid between Jul 2019 and Mar 2021, across 5 billing codes. Its largest line is D0120, dental checkup, returning patient — 40% of everything it billed.

33Billing provider info4TH AVENUE DENTAL, PA, DBA OAK PARK DENTAL
PINE CITY, MN 55063

33aNPI1609298355assigned 01/15/2014

33bProvider typeGeneral Practice Dentistry

28Total paid$7K

24GClaims231

24DCodes billed5

24AFirst – last monthJul 2019 – Mar 2021

Compared with peers

Next to other General Practice Dentistry providers in Minnesota

Rank by total paid#230 of 368

Median peer was paid$19K

This provider vs. median0.3×

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
2019	107	$3K
2020	91	$3K
2021	33	$907.04

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	40%	89	89	$3K
D1206	Topical application of fluoride varnish	39%	105	105	$3K
D1110	Prophylaxis - adult	8.5%	12	12	$554.80
D0274	Bitewings - four radiographic images	7.1%	13	13	$467.56
D1120	Dental cleaning, childProphylaxis - child	5.8%	12	12	$378.84

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 officialASCHEMAN, ALICIA (SUPERVISOR/OWNER)