Old Hickory Family Dentistry

Old Hickory Family Dentistry was paid $25K by Medicaid between Aug 2019 and Mar 2020, across 11 billing codes. Its largest line is D2392, Resin-based composite - two surfaces, posterior, primary or permanent — 26% of everything it billed.

33Billing provider infoOLD HICKORY FAMILY DENTISTRY
OLD HICKORY, TN 37138

33aNPI1689116394assigned 11/11/2016

33bProvider typeDental Clinic/Center

28Total paid$25K

24GClaims821

24DCodes billed11

24AFirst – last monthAug 2019 – Mar 2020

Compared with peers

Next to other Dental Clinic/Center providers in Tennessee

Rank by total paid#37 of 40

Median peer was paid$259K

This provider vs. median0.1×

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
2019	672	$21K
2020	149	$4K

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	26%	86	32	$6K
D1110	Prophylaxis - adult	20%	128	121	$5K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	13%	146	141	$3K
D1208	Topical application of fluoride, excluding varnish	12%	154	149	$3K
D2391	Resin-based composite - one surface, posterior, primary or permanent	8.2%	32	14	$2K
D1120	Dental cleaning, childProphylaxis - child	6.1%	49	48	$2K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	4.1%	35	34	$1K
D0274	Bitewings - four radiographic images	3.8%	46	40	$939.98
D0150	Comprehensive oral evaluation - new or established patient	3.1%	28	27	$769.75
D0220	Intraoral - periapical first radiographic image	2.6%	60	55	$634.00
D0230	Intraoral - periapical each additional radiographic image	1.7%	57	47	$423.18

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 officialGLASMEIER, MIKE (DENTIST/OWNER)