DRIPPING SPRINGS PEDIATRIC DENTAL, PLLC

NPI: 1639610421 · DRIPPING SPRINGS, TX 78620 · Pediatric Dentist · NPI assigned 03/14/2017

Billing Flags · Automated signals — not evidence of fraud

Entity Proliferation

Authorized official MONTGOMERY, MARTY controls 11+ related entities in our dataset. Read more

$28K

Total Medicaid Paid

1,746

Total Claims

1,612

Beneficiaries

Codes Billed

2020-11

First Month

2021-06

Last Month

Provider Details

Authorized Official	MONTGOMERY, MARTY (OWNER)
NPI Enumeration Date	03/14/2017

Other providers sharing the same authorized official: MONTGOMERY, MARTY

Provider	City	State	Total Paid
NORTH AUSTIN PEDIATRIC DENTAL, PLLC	AUSTIN	TX	$874K
LONE STAR PEDIATRIC DENTAL, PLLC	AUSTIN	TX	$746K
ELGIN PEDIATRIC DENTAL PLLC	ELGIN	TX	$397K
KYLE PEDIATRIC DENTAL	KYLE	TX	$352K
LSPD AT KILLEEN, PLLC	KILLEEN	TX	$259K
T & S OMFS PLLC	AUSTIN	TX	$188K
LAKEWAY PEDIATRIC DENTAL, PLLC	AUSTIN	TX	$134K
CENTRAL AUSTIN PEDIATRIC DENTAL, PLLC	AUSTIN	TX	$122K
LSPD AT COVE PLLC	COPPERAS COVE	TX	$106K
LSPD AT CIRCLE C, PLLC	AUSTIN	TX	$69K
CHILDREN'S DENTAL RANCH OF NEW BRAUNFELS, PLLC	NEW BRAUNFELS	TX	$22K

Year	Claims	Total Paid
2020	445	$7K
2021	1,301	$20K

Code	Description	Claims	Beneficiaries	Total Paid
D1120	Prophylaxis - child	174	173	$6K
D0120	Periodic oral evaluation - established patient	184	182	$5K
D1351	Sealant - per tooth	133	27	$3K
D1208	Topical application of fluoride, excluding varnish	238	236	$3K
D0272	Bitewings - two radiographic images	148	148	$3K
D0220	Intraoral - periapical first radiographic image	244	242	$3K
D0230	Intraoral - periapical each additional radiographic image	257	239	$3K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	25	24	$513.01
D0150	Comprehensive oral evaluation - new or established patient	12	12	$409.72
D0330	Panoramic radiographic image	24	24	$349.31
D0603		307	305	$0.00