STONE GATE DENTAL ASSOCIATES INC.
NPI: 1639733389
· SAINT CLOUD, MN 56303
· Dental Clinic/Center
· NPI assigned 04/29/2019
$184K
Total Medicaid Paid
Provider Details
| Authorized Official | COLLIER, JOHN (OWNER) |
| NPI Enumeration Date | 04/29/2019 |
Related Entities
Other providers sharing the same authorized official: COLLIER, JOHN
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
66 |
$2K |
| 2020 |
215 |
$5K |
| 2021 |
589 |
$17K |
| 2022 |
926 |
$39K |
| 2023 |
1,641 |
$67K |
| 2024 |
1,268 |
$53K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,199 |
1,190 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,872 |
1,861 |
$61K |
| D1120 |
Prophylaxis - child |
634 |
630 |
$24K |
| D0274 |
Bitewings - four radiographic images |
327 |
324 |
$14K |
| D0272 |
Bitewings - two radiographic images |
239 |
239 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
221 |
221 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
45 |
27 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
49 |
49 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
84 |
75 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
15 |
$1K |
| D1999 |
|
18 |
18 |
$0.00 |