Dental
Wagoner Family Dental, PLLC
Wagoner Family Dental, PLLC was paid $187K by Medicaid between Dec 2023 and Nov 2024, across 16 billing codes. Its largest line is D2392, Resin-based composite - two surfaces, posterior, primary or permanent — 29% of everything it billed.
33Billing provider infoWAGONER FAMILY DENTAL, PLLC
WAGONER, OK 74467
WAGONER, OK 74467
33aNPI1669245577assigned 11/02/2023
33bProvider typeGeneral Practice Dentistry
28Total paid$187K
24GClaims4,667
24DCodes billed16
24AFirst – last monthDec 2023 – Nov 2024
Compared with peers
Next to other General Practice Dentistry providers in Oklahoma
Rank by total paid#138 of 284
Median peer was paid$172K
This provider vs. median1.1×
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 | |
|---|---|---|---|
| 2023 | 57 | $1K | |
| 2024incomplete | 4,610 | $186K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 29% | 453 | 155 | $55K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 14% | 149 | 54 | $26K |
| D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | 7.3% | 102 | 27 | $14K |
| D1110 | Prophylaxis - adult | 7.1% | 287 | 267 | $13K |
| D0330 | Panoramic radiographic image | 6.0% | 224 | 210 | $11K |
| D0220 | Intraoral - periapical first radiographic image | 5.8% | 700 | 644 | $11K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 5.6% | 494 | 465 | $11K |
| D0274 | Bitewings - four radiographic images | 5.1% | 306 | 284 | $10K |
| D0150 | Comprehensive oral evaluation - new or established patient | 5.1% | 307 | 284 | $10K |
| D1206 | Topical application of fluoride varnish | 5.0% | 507 | 480 | $9K |
| D1120 | Dental cleaning, childProphylaxis - child | 4.7% | 289 | 270 | $9K |
| D0230 | Intraoral - periapical each additional radiographic image | 2.6% | 630 | 531 | $5K |
4 more codes
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 officialDAVIS, LILY (CREDENTIALING MANAGER)
| Provider | Location | Paid |
|---|---|---|
| Willow Dental LLC | Omaha, NE | $74K |
| Hooyah Health Center LLC | Hillsboro, OR | $28K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.