GREAT OUTDOORS PEDIATRIC DENTISTRY
NPI: 1831584929
· DOVER, NH 03820
· Pediatric Dentist
· NPI assigned 04/06/2015
$365K
Total Medicaid Paid
Provider Details
| Authorized Official | WILSON, PATRICK (OWNER, PRESIDENT) |
| NPI Enumeration Date | 04/06/2015 |
Related Entities
Other providers sharing the same authorized official: WILSON, PATRICK
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,184 |
$34K |
| 2019 |
1,555 |
$46K |
| 2020 |
1,626 |
$49K |
| 2021 |
1,920 |
$55K |
| 2022 |
2,558 |
$86K |
| 2023 |
1,725 |
$51K |
| 2024 |
1,530 |
$44K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,132 |
2,940 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
2,725 |
2,590 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,648 |
3,408 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
315 |
170 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
569 |
511 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
557 |
502 |
$21K |
| D0272 |
Bitewings - two radiographic images |
818 |
764 |
$20K |
| D1351 |
Sealant - per tooth |
242 |
93 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
55 |
$3K |
| D1310 |
|
32 |
25 |
$380.00 |