Dental
South Davis Pediatric Dentistry LLC
South Davis Pediatric Dentistry LLC was paid $66K by Medicaid between Jul 2023 and Dec 2024, across 9 billing codes. Its largest line is D1120, dental cleaning, child — 33% of everything it billed.
33Billing provider infoSOUTH DAVIS PEDIATRIC DENTISTRY LLC
BOUNTIFUL, UT 84010
BOUNTIFUL, UT 84010
33aNPI1841891462assigned 11/02/2020
33bProvider typePediatric Dentist
28Total paid$66K
24GClaims2,053
24DCodes billed9
24AFirst – last monthJul 2023 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Utah
Rank by total paid#119 of 152
Median peer was paid$311K
This provider vs. median0.2×
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 | |
|---|---|---|---|
| 2023 | 304 | $9K | |
| 2024incomplete | 1,749 | $57K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 33% | 502 | 498 | $22K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 21% | 502 | 499 | $14K |
| D0272 | Bitewings - two radiographic images | 16% | 382 | 379 | $10K |
| D1206 | Topical application of fluoride varnish | 15% | 461 | 456 | $10K |
| D2150 | Silver amalgam - two surfaces, primary or permanent | 8.2% | 63 | 12 | $5K |
| D0274 | Bitewings - four radiographic images | 2.8% | 47 | 47 | $2K |
| D1351 | Sealant - per tooth | 2.4% | 70 | 12 | $2K |
| D1110 | Prophylaxis - adult | 1.0% | 12 | 12 | $665.31 |
| D0150 | Comprehensive oral evaluation - new or established patient | <1% | 14 | 14 | $592.76 |
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 officialODION, CHARLES (OWNER)
| Provider | Location | Paid |
|---|---|---|
| Redwood Pediatric Dentistry | Taylorsville, UT | $50K |
| Herriman Pediatric Dentistry | Herriman, UT | $49K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.