Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › OK › LOCUST GROVE › MAIN STREET DENTAL, PLLC

MAIN STREET DENTAL, PLLC

NPI: 1679072664 · LOCUST GROVE, OK 74352 · Dental Clinic/Center · NPI assigned 02/06/2018

$18K
Total Medicaid Paid
860
Total Claims
851
Beneficiary Records
7
Codes Billed
2018-05
First Month
2020-06
Last Month

Provider Details

Authorized OfficialHENRY, DAVID (OWNER)
NPI Enumeration Date02/06/2018

Related Entities

Other providers sharing the same authorized official: HENRY, DAVID

ProviderCityStateTotal Paid
SANTA CLARITA EMERGENCY MEDICAL GROUP INC VALENCIA CA $5.21M
ACCESS HEALTHCARE PC HARTFORD CT $800K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 576 $13K
2019 255 $5K
2020 29 $527.50

Billing Codes

CodeDescriptionClaimsBene. RecordsTotal Paid
D0120 Periodic oral evaluation - established patient 260 260 $5K
D1206 Topical application of fluoride varnish 327 327 $5K
D1120 Prophylaxis - child 150 150 $4K
D2391 Resin-based composite - one surface, posterior, primary or permanent 21 12 $1K
D1110 Prophylaxis - adult 28 28 $1K
D0274 Bitewings - four radiographic images 38 38 $1K
D0220 Intraoral - periapical first radiographic image 36 36 $497.77