Dental
Westside Pediatric Dentistry
Westside Pediatric Dentistry was paid $240K by Medicaid between Jan 2018 and Oct 2018, across 19 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 25% of everything it billed.
33Billing provider infoWESTSIDE PEDIATRIC DENTISTRY
RIO RANCHO, NM 87124
RIO RANCHO, NM 87124
33aNPI1790808111assigned 04/09/2007
33bProvider typePediatric Dentist
28Total paid$240K
24GClaims8,026
24DCodes billed19
24AFirst – last monthJan 2018 – Oct 2018
Compared with peers
Next to other Pediatric Dentist providers in New Mexico
Rank by total paid#23 of 44
Median peer was paid$240K
This provider vs. median1.0×
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 | |
|---|---|---|---|
| 2018 | 8,026 | $240K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 25% | 615 | 192 | $61K |
| D1120 | Dental cleaning, childProphylaxis - child | 10% | 966 | 821 | $25K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 10.0% | 337 | 112 | $24K |
| D0150 | Comprehensive oral evaluation - new or established patient | 6.5% | 545 | 458 | $16K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 6.1% | 254 | 129 | $15K |
| D1208 | Topical application of fluoride, excluding varnish | 5.9% | 953 | 807 | $14K |
| D0272 | Bitewings - two radiographic images | 5.3% | 745 | 638 | $13K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 3.8% | 491 | 420 | $9K |
| D0220 | Intraoral - periapical first radiographic image | 3.7% | 954 | 819 | $9K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 3.7% | 181 | 75 | $9K |
| D9420 | 3.6% | 134 | 119 | $9K | |
| D0140 | Limited oral evaluation - problem focused | 3.2% | 296 | 260 | $8K |
7 more codes
| D0230 | Intraoral - periapical each additional radiographic image | 2.9% | 911 | $7K |
| D7140 | Extraction, erupted tooth or exposed root | 2.5% | 103 | $6K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 2.4% | 260 | $6K |
| D0210 | Intraoral - complete series of radiographic images | 1.8% | 75 | $4K |
| D2932 | 1.7% | 34 | $4K | |
| D1351 | Sealant - per tooth | 1.1% | 153 | $3K |
| D0274 | Bitewings - four radiographic images | <1% | 19 | $378.48 |
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 officialBROUSSARD, RAYMOND (OWNER)