Dental
Out of This World Dentistry SJ PC
Out of This World Dentistry SJ PC was paid $116K by Medicaid between Jan 2018 and Dec 2024, across 9 billing codes. Its largest line is D0120, dental checkup, returning patient — 72% of everything it billed.
33Billing provider infoOUT OF THIS WORLD DENTISTRY SJ PC
SOUTH JORDAN, UT 84009
SOUTH JORDAN, UT 84009
33aNPI1811396260assigned 08/21/2014
33bProvider typePediatric Dentist
28Total paid$116K
24GClaims4,838
24DCodes billed9
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Utah
Rank by total paid#110 of 152
Median peer was paid$311K
This provider vs. median0.4×
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 | 751 | $17K | |
| 2019 | 45 | $188.83 | |
| 2020 | 193 | $6K | |
| 2021 | 890 | $20K | |
| 2022 | 1,668 | $39K | |
| 2023 | 542 | $13K | |
| 2024incomplete | 749 | $20K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 72% | 1,034 | 1,020 | $84K |
| D1120 | Dental cleaning, childProphylaxis - child | 12% | 1,078 | 1,065 | $14K |
| D1206 | Topical application of fluoride varnish | 7.8% | 1,108 | 1,092 | $9K |
| D0220 | Intraoral - periapical first radiographic image | 4.2% | 685 | 665 | $5K |
| D0230 | Intraoral - periapical each additional radiographic image | 1.5% | 565 | 518 | $2K |
| D0150 | Comprehensive oral evaluation - new or established patient | 1.3% | 29 | 27 | $1K |
| D0272 | Bitewings - two radiographic images | <1% | 313 | 313 | $819.19 |
| D1110 | Prophylaxis - adult | 0% | 13 | 12 | $0.00 |
| D0274 | Bitewings - four radiographic images | 0% | 13 | 13 | $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 officialSTARK, CORY (OWNER)
Parent organizationOUT OF THIS WORLD DENTISTRY PC