ST. GEORGE KIDS DENTAL AT SNOW CANYON
NPI: 1639667801
· SANTA CLARA, UT 84765
· Pediatric Dentist
· NPI assigned 04/24/2018
$137K
Total Medicaid Paid
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
466 |
$9K |
| 2019 |
467 |
$9K |
| 2020 |
733 |
$13K |
| 2021 |
1,549 |
$39K |
| 2022 |
1,974 |
$44K |
| 2023 |
503 |
$12K |
| 2024 |
446 |
$10K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
911 |
906 |
$95K |
| D1120 |
Prophylaxis - child |
1,185 |
1,177 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
65 |
65 |
$9K |
| D0272 |
Bitewings - two radiographic images |
603 |
597 |
$8K |
| D1206 |
Topical application of fluoride varnish |
1,111 |
1,099 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
81 |
53 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
1,044 |
1,032 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,138 |
975 |
$3K |