MAIN STREET CHILDRENS DENTISTRY AND ORTHODONTICS OF LAKEWOOD RANCH PLL

NPI: 1790273159 · BRADENTON, FL 34202 · Orthodontics and Dentofacial Orthopedic Dentist · NPI assigned 05/01/2018

Billing Flags · Automated signals — not evidence of fraud

Entity Proliferation

Authorized official GOMEZ, STEPHANIE controls 20+ related entities in our dataset. Read more

$360K

Total Medicaid Paid

18,528

Total Claims

14,290

Beneficiaries

Codes Billed

2020-05

First Month

2022-10

Last Month

Provider Details

Authorized Official	GOMEZ, STEPHANIE (CREDENTIALING SUPERVISOR)
NPI Enumeration Date	05/01/2018

Other providers sharing the same authorized official: GOMEZ, STEPHANIE

Provider	City	State	Total Paid
DENTISTRY FOR CHILDREN PC	YONKERS	NY	$4.59M
MAIN STREET CHILDREN'S DENTISTRY OF MIAMI LAKES, PLLC	MIAMI LAKES	FL	$2.59M
MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF CLERMONT, PLLC	CLERMONT	FL	$2.38M
DENTAL CENTER AT FOREST HILL, PA	WEST PALM BEACH	FL	$2.29M
MAIN STREET CHILDREN'S DENTISTRY & ORTHODONTICS OF PALMETTO BAY, PA	PALMETTO BAY	FL	$2.22M
MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF CAPE CORAL, P.A.	CAPE CORAL	FL	$2.21M
MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF HOMESTEAD, P.A.	HOMESTEAD	FL	$2.10M
MAIN STREET CHILDRENS DENTISTRY AND ORTHODONTICS WATERFORD LAKES PLLC	ORLANDO	FL	$1.82M
MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF FT. MYERS, P.A.	FORT MYERS	FL	$1.80M
MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF WINTER PARK, PA	WINTER PARK	FL	$1.68M
MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF ORANGE CITY, P.A.	ORANGE CITY	FL	$1.58M
DENTAL SPECIALTY CENTER OF FT. MYERS, PA	FORT MYERS	FL	$1.40M
PALM DENTAL CENTER, PA	HIALEAH	FL	$1.27M
MAIN STREET CHILDREN'S DENTISTRY & ORTHODONTICS OF NAPLES, PA	NAPLES	FL	$1.16M
MAIN STREET CHILDREN'S DENTISTRY OF AVENTURA, PA	AVENTURA	FL	$1.06M
TDG DENTAL GROUP PLLC	WOODBRIDGE	VA	$1.01M
DENTAL CENTER AT BAPTIST, PA	MIAMI	FL	$851K
SUNRISE DENTAL GROUP P.A.	PLANTATION	FL	$833K
MAIN STREET CHILDREN'S DENTISTRY OF JUPITER, PA	JUPITER	FL	$824K
MAIN STREET CHILDREN'S DENTISTRY AND ORTHODONTICS OF SOUTH BROWARD, PA	COOPER CITY	FL	$717K

Code	Description	Claims	Beneficiaries	Total Paid
D0120	Periodic oral evaluation - established patient	1,222	1,210	$87K
D3220	Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction	234	159	$68K
D0150	Comprehensive oral evaluation - new or established patient	837	824	$55K
D0230	Intraoral - periapical each additional radiographic image	4,429	1,621	$49K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	691	369	$47K
D2930	Prefabricated stainless steel crown - primary tooth	490	273	$14K
D7140	Extraction, erupted tooth or exposed root	409	276	$12K
D0210	Intraoral - complete series of radiographic images	74	74	$8K
D0330	Panoramic radiographic image	77	77	$5K
D0140	Limited oral evaluation - problem focused	84	84	$3K
D1110	Prophylaxis - adult	26	26	$2K
D1120	Prophylaxis - child	1,998	1,972	$2K
D0999	Unspecified diagnostic procedure, by report	105	105	$2K
D1351	Sealant - per tooth	784	276	$2K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	721	702	$1K
D9999	Unspecified adjunctive procedure, by report	38	38	$760.00
D0220	Intraoral - periapical first radiographic image	1,832	1,776	$137.68
D1206	Topical application of fluoride varnish	1,792	1,772	$115.45
D0272	Bitewings - two radiographic images	317	314	$106.00
D1330		2,022	2,000	$79.00
D0274	Bitewings - four radiographic images	107	105	$28.00
D1208	Topical application of fluoride, excluding varnish	239	237	$0.00