Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › OK › OKLAHOMA CITY › DENTAL DEPOT OF MUSTANG, PLLC

DENTAL DEPOT OF MUSTANG, PLLC

NPI: 1679323182 · OKLAHOMA CITY, OK 73099 · Dental Clinic/Center · NPI assigned 03/26/2024

Billing Flags · Automated signals — not evidence of fraud
Entity Proliferation

Authorized official ZISSA, GAYLON controls 13+ related entities in our dataset. Read more

$5K
Total Medicaid Paid
223
Total Claims
217
Beneficiary Records
6
Codes Billed
2024-11
First Month
2024-12
Last Month

Provider Details

Authorized OfficialZISSA, GAYLON (DIRECTOR OF PROVIDER RELATIONS)
NPI Enumeration Date03/26/2024

Related Entities

Other providers sharing the same authorized official: ZISSA, GAYLON

ProviderCityStateTotal Paid
DENTAL DEPOT SOUTH OKLAHOMA CITY OK $3.40M
DENTAL DEPOT ORTHODONTICS CENTRAL OKC PLLC OKLAHOMA CITY OK $3.31M
DENTAL DEPOT ORTHODONTICS SOUTH PLLC OKLAHOMA CITY OK $2.53M
DENTAL DEPOT OF I-44 & GARNETT, PLLC TULSA OK $1.34M
DENTAL DEPOT ORTHODONTICS NORTH OKC PLLC OKLAHOMA CITY OK $1.22M
DENTAL DEPOT ORTHODONTICS YUKON PLLC YUKON OK $1.04M
DENTAL DEPOT OF 164TH & PORTLAND PLLC OKLAHOMA CITY OK $546K
DENTAL DEPOT OF DEL CITY, PLLC DEL CITY OK $438K
DENTAL DEPOT ORTHODONTICS TECUMSEH, PLLC NORMAN OK $107K
DENTAL DEPOT OF ARLINGTON PLLC ARLINGTON TX $31K
DENTAL DEPOT ORTHODONTICS DEL CITY, PLLC DEL CITY OK $21K
DENTAL DEPOT OF BLUE SPRINGS PLLC BLUE SPRINGS MO $21K
DENTAL DEPOT OF INDEPENDENCE, PLLC INDEPENDENCE MO $6K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2024 223 $5K

Billing Codes

CodeDescriptionClaimsBene. RecordsTotal Paid
D0330 Panoramic radiographic image 30 30 $1K
D0274 Bitewings - four radiographic images 35 35 $1K
D0150 Comprehensive oral evaluation - new or established patient 32 32 $1K
D0220 Intraoral - periapical first radiographic image 48 47 $736.43
D1206 Topical application of fluoride varnish 28 28 $523.22
D0230 Intraoral - periapical each additional radiographic image 50 45 $384.16