Dental
Fiesta Kids Dental LLC
Fiesta Kids Dental LLC was paid $49K by Medicaid between Jan 2018 and Jul 2021, across 21 billing codes. Its largest line is D1120, dental cleaning, child — 24% of everything it billed.
33Billing provider infoFIESTA KIDS DENTAL LLC
MESA, AZ 85202
MESA, AZ 85202
33aNPI1770840951assigned 04/12/2012
33bProvider typePediatric Dentist
28Total paid$49K
24GClaims29,157
24DCodes billed21
24AFirst – last monthJan 2018 – Jul 2021
Compared with peers
Next to other Pediatric Dentist providers in Arizona
Rank by total paid#98 of 223
Median peer was paid$24K
This provider vs. median2.1×
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 | |
|---|---|---|---|
| 2018 | 11,460 | $12K | |
| 2019 | 14,549 | $32K | |
| 2020 | 2,934 | $5K | |
| 2021 | 214 | $0.00 |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 24% | 4,056 | 3,869 | $12K |
| D1206 | Topical application of fluoride varnish | 12% | 4,398 | 4,204 | $6K |
| D0272 | Bitewings - two radiographic images | 9.0% | 2,909 | 2,795 | $4K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 8.9% | 331 | 105 | $4K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 8.9% | 3,350 | 3,237 | $4K |
| D0220 | Intraoral - periapical first radiographic image | 7.4% | 4,144 | 3,937 | $4K |
| D0230 | Intraoral - periapical each additional radiographic image | 6.0% | 4,319 | 3,746 | $3K |
| D0150 | Comprehensive oral evaluation - new or established patient | 4.8% | 393 | 347 | $2K |
| D0330 | Panoramic radiographic image | 4.7% | 743 | 719 | $2K |
| D1351 | Sealant - per tooth | 4.7% | 762 | 194 | $2K |
| D1354 | 3.6% | 1,635 | 350 | $2K | |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 2.0% | 766 | 662 | $985.75 |
9 more codes
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 1.5% | 521 | $752.94 |
| D0145 | Oral evaluation for a patient under three years of age | 1.1% | 205 | $539.90 |
| D0274 | Bitewings - four radiographic images | <1% | 291 | $321.49 |
| D1110 | Prophylaxis - adult | <1% | 139 | $197.12 |
| D7140 | Extraction, erupted tooth or exposed root | <1% | 118 | $133.40 |
| D9248 | <1% | 29 | $70.18 | |
| D0140 | Limited oral evaluation - problem focused | <1% | 13 | $34.44 |
| D0601 | 0% | 14 | $0.00 | |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 0% | 21 | $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 officialMONTOYA, STEPHEN (OWNER)
| Provider | Location | Paid |
|---|---|---|
| Texas Super Smiles for Kids LLC | Plainview, TX | $735K |
| Montoya Pediatric Dentistry LLC Dba San Tan Pediatric Dental | Queen Creek, AZ | $235K |
| Frankford Dental Group | Lubbock, TX | $19K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.