Clinic
Kodiak Island Family Dentistry
Kodiak Island Family Dentistry was paid $75K by Medicaid between Jun 2021 and Jul 2024, across 10 billing codes. Its largest line is D1206, Topical application of fluoride varnish — 28% of everything it billed.
33Billing provider infoKODIAK ISLAND FAMILY DENTISTRY
KODIAK, AK 99615
KODIAK, AK 99615
33aNPI1811568900assigned 07/08/2021
33bProvider typeDental Clinic/Center
28Total paid$75K
24GClaims2,480
24DCodes billed10
24AFirst – last monthJun 2021 – Jul 2024
Compared with peers
Next to other Dental Clinic/Center providers in Alaska
Rank by total paid#23 of 40
Median peer was paid$94K
This provider vs. median0.8×
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 | |
|---|---|---|---|
| 2021 | 1,097 | $27K | |
| 2022 | 1,026 | $34K | |
| 2023 | 192 | $7K | |
| 2024incomplete | 165 | $7K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1206 | Topical application of fluoride varnish | 28% | 1,025 | 750 | $21K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 24% | 535 | 393 | $18K |
| D1120 | Dental cleaning, childProphylaxis - child | 20% | 303 | 244 | $15K |
| D1110 | Prophylaxis - adult | 11% | 165 | 113 | $8K |
| D4910 | 5.2% | 71 | 41 | $4K | |
| D0220 | Intraoral - periapical first radiographic image | 3.1% | 154 | 99 | $2K |
| D0274 | Bitewings - four radiographic images | 3.1% | 69 | 42 | $2K |
| D0150 | Comprehensive oral evaluation - new or established patient | 2.3% | 52 | 26 | $2K |
| D1351 | Sealant - per tooth | 2.3% | 50 | 12 | $2K |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 56 | 28 | $616.05 |
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 officialLEIVA, TABITHA (OFFICE MANAGER)