Dental
Idaho Falls Pediatric Dentistry, PLLC
Idaho Falls Pediatric Dentistry, PLLC was paid $1.17M by Medicaid between Sep 2019 and Dec 2024, across 24 billing codes. Its largest line is D1120, dental cleaning, child — 26% of everything it billed.
33Billing provider infoIDAHO FALLS PEDIATRIC DENTISTRY, PLLC
AMMON, ID 83406
AMMON, ID 83406
33aNPI1700447596assigned 06/24/2019
33bProvider typePediatric Dentist
28Total paid$1.17M
24GClaims58,446
24DCodes billed24
24AFirst – last monthSep 2019 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Idaho
Rank by total paid#16 of 53
Median peer was paid$394K
This provider vs. median3.0×
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 | 717 | $11K | |
| 2020 | 7,690 | $169K | |
| 2021 | 12,568 | $244K | |
| 2022 | 13,571 | $283K | |
| 2023 | 13,195 | $276K | |
| 2024incomplete | 10,705 | $189K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 26% | 6,940 | 6,933 | $308K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 18% | 2,394 | 640 | $210K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 12% | 1,695 | 1,036 | $140K |
| D0145 | Oral evaluation for a patient under three years of age | 7.2% | 1,204 | 1,203 | $85K |
| D0150 | Comprehensive oral evaluation - new or established patient | 7.0% | 1,747 | 1,746 | $82K |
| D0210 | Intraoral - complete series of radiographic images | 6.9% | 853 | 849 | $81K |
| D1110 | Prophylaxis - adult | 6.8% | 966 | 966 | $80K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 6.1% | 1,382 | 883 | $71K |
| D0140 | Limited oral evaluation - problem focused | 3.4% | 1,860 | 1,774 | $39K |
| D7140 | Extraction, erupted tooth or exposed root | 2.4% | 813 | 412 | $28K |
| D0330 | Panoramic radiographic image | 1.9% | 786 | 785 | $22K |
| D1351 | Sealant - per tooth | 1.8% | 4,996 | 1,039 | $21K |
12 more codes
| D2332 | <1% | 18 | $1K | |
| D1206 | Topical application of fluoride varnish | <1% | 7,462 | $1K |
| D0274 | Bitewings - four radiographic images | <1% | 817 | $739.85 |
| D0120 | Dental checkup, returning patient | <1% | 4,890 | $456.29 |
| D0220 | Intraoral - periapical first radiographic image | <1% | 5,540 | $413.19 |
| D0272 | Bitewings - two radiographic images | <1% | 4,327 | $286.26 |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 5,698 | $252.52 |
| D9420 | <1% | 241 | $92.27 | |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | <1% | 2,542 | $16.42 |
| D0240 | 0% | 178 | $0.00 | |
| D1999 | 0% | 1,084 | $0.00 | |
| D9986 | 0% | 13 | $0.00 |
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 officialHOUSLEY, KAILEY (PEDIATRIC DENTIST, OWNER)