Dental
Rose Park Pediatric Dentistry, PC
Rose Park Pediatric Dentistry, PC was paid $1.77M by Medicaid between Jan 2018 and Dec 2024, across 20 billing codes. Its largest line is D0120, dental checkup, returning patient — 48% of everything it billed.
33Billing provider infoROSE PARK PEDIATRIC DENTISTRY, PC
SALT LAKE CITY, UT 84116
SALT LAKE CITY, UT 84116
33aNPI1831338623assigned 02/18/2009
33bProvider typePediatric Dentist
28Total paid$1.77M
24GClaims55,238
24DCodes billed20
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Utah
Rank by total paid#16 of 152
Median peer was paid$311K
This provider vs. median5.7×
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 | 265 | $372.17 | |
| 2019 | 2,385 | $57K | |
| 2020 | 2,691 | $79K | |
| 2021 | 12,798 | $428K | |
| 2022 | 18,640 | $601K | |
| 2023 | 14,651 | $475K | |
| 2024incomplete | 3,808 | $133K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 48% | 10,225 | 10,115 | $851K |
| D1351 | Sealant - per tooth | 7.4% | 3,779 | 854 | $132K |
| D0220 | Intraoral - periapical first radiographic image | 7.3% | 1,686 | 1,654 | $129K |
| D1120 | Dental cleaning, childProphylaxis - child | 6.7% | 10,226 | 10,094 | $119K |
| D0272 | Bitewings - two radiographic images | 5.8% | 8,536 | 8,450 | $103K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 4.8% | 1,271 | 716 | $84K |
| D0150 | Comprehensive oral evaluation - new or established patient | 4.0% | 751 | 741 | $70K |
| D1206 | Topical application of fluoride varnish | 3.6% | 10,881 | 10,738 | $64K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 2.2% | 740 | 475 | $38K |
| D2150 | Silver amalgam - two surfaces, primary or permanent | 1.7% | 1,048 | 617 | $30K |
| D7140 | Extraction, erupted tooth or exposed root | 1.6% | 683 | 376 | $28K |
| D0330 | Panoramic radiographic image | 1.4% | 1,285 | 1,273 | $25K |
8 more codes
| D2140 | 1.3% | 801 | $24K | |
| D1110 | Prophylaxis - adult | 1.2% | 855 | $21K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 1.0% | 383 | $18K |
| D0274 | Bitewings - four radiographic images | 1.0% | 818 | $18K |
| D0140 | Limited oral evaluation - problem focused | <1% | 228 | $9K |
| D1208 | Topical application of fluoride, excluding varnish | <1% | 322 | $3K |
| D9420 | <1% | 50 | $3K | |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 670 | $2K |
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 officialJOHANSEN, RICHARD (OWNER)
Parent organization49534949923