OUT OF THIS WORLD DENTISTRY SJ PC
NPI: 1811396260
· SOUTH JORDAN, UT 84009
· Pediatric Dentist
· NPI assigned 08/21/2014
$116K
Total Medicaid Paid
Provider Details
| Authorized Official | STARK, CORY (OWNER) |
| Parent Organization | OUT OF THIS WORLD DENTISTRY PC |
| NPI Enumeration Date | 08/21/2014 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
751 |
$17K |
| 2019 |
45 |
$188.83 |
| 2020 |
193 |
$6K |
| 2021 |
890 |
$20K |
| 2022 |
1,668 |
$39K |
| 2023 |
542 |
$13K |
| 2024 |
749 |
$20K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,034 |
1,020 |
$84K |
| D1120 |
Prophylaxis - child |
1,078 |
1,065 |
$14K |
| D1206 |
Topical application of fluoride varnish |
1,108 |
1,092 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
685 |
665 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
565 |
518 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
27 |
$1K |
| D0272 |
Bitewings - two radiographic images |
313 |
313 |
$819.19 |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$0.00 |