Premiere Family Dentistry of Tahlequah, PLLC

Premiere Family Dentistry of Tahlequah, PLLC was paid $60K by Medicaid between Feb 2022 and Jul 2022, across 12 billing codes. Its largest line is D2392, Resin-based composite - two surfaces, posterior, primary or permanent — 21% of everything it billed.

33Billing provider infoPREMIERE FAMILY DENTISTRY OF TAHLEQUAH, PLLC
TAHLEQUAH, OK 74464

33aNPI1780340513assigned 11/16/2021

33bProvider typeDental Clinic/Center

28Total paid$60K

24GClaims2,071

24DCodes billed12

24AFirst – last monthFeb 2022 – Jul 2022

Compared with peers

Next to other Dental Clinic/Center providers in Oklahoma

Rank by total paid#65 of 112

Median peer was paid$86K

This provider vs. median0.7×

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.

Auditor's notes

Automated statistical signals. Not evidence of fraud — how these are computed.

Entity ProliferationAuthorized official SMITH, MARK controls 20+ related entities in our dataset. Read more

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
2022	2,071	$60K

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	21%	143	86	$12K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	17%	501	501	$10K
D1110	Prophylaxis - adult	17%	225	225	$10K
D1120	Dental cleaning, childProphylaxis - child	13%	252	252	$8K
D1208	Topical application of fluoride, excluding varnish	12%	484	484	$7K
D0274	Bitewings - four radiographic images	6.0%	121	121	$4K
D2391	Resin-based composite - one surface, posterior, primary or permanent	5.5%	56	39	$3K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	3.3%	81	75	$2K
D0220	Intraoral - periapical first radiographic image	2.6%	104	104	$2K
D0272	Bitewings - two radiographic images	1.5%	50	50	$915.00
D0330	Panoramic radiographic image	<1%	12	12	$585.24
D0230	Intraoral - periapical each additional radiographic image	<1%	42	31	$320.04

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 officialSMITH, MARK (SENIOR MANAGER)

Same official

Other billing entities under SMITH, MARK

Full network →

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T H Smith Od and Thomas K Smith Od PC	Mc Kenzie, TN	$263K
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Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.