Shelly Self DMD PLLC

Shelly Self DMD PLLC was paid $63K by Medicaid between Jan 2018 and Dec 2018, across 9 billing codes. Its largest line is D9920, — 20% of everything it billed.

33Billing provider infoSHELLY SELF DMD PLLC
POULSBO, WA 98370

33aNPI1780003723assigned 04/07/2014

33bProvider typeDental Clinic/Center

28Total paid$63K

24GClaims3,104

24DCodes billed9

24AFirst – last monthJan 2018 – Dec 2018

Compared with peers

Next to other Dental Clinic/Center providers in Washington

Rank by total paid#108 of 143

Median peer was paid$573K

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
2018	3,104	$63K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D9920		20%	492	468	$12K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	20%	484	459	$12K
D1120	Dental cleaning, childProphylaxis - child	17%	543	516	$11K
D1206	Topical application of fluoride varnish	17%	519	492	$11K
D9999	Unspecified adjunctive procedure, by report	15%	388	368	$9K
D0272	Bitewings - two radiographic images	4.9%	339	322	$3K
D0150	Comprehensive oral evaluation - new or established patient	3.9%	70	67	$2K
D0220	Intraoral - periapical first radiographic image	1.8%	151	148	$1K
D0230	Intraoral - periapical each additional radiographic image	<1%	118	116	$260.70

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 officialSELF, MCKINLEY (MANAGER)