Cheyenne River Dental Clinic

Cheyenne River Dental Clinic was paid $1.60M by Medicaid between Jan 2018 and Oct 2024, across 16 billing codes. Its largest line is D0140, Limited oral evaluation - problem focused — 49% of everything it billed.

33Billing provider infoCHEYENNE RIVER DENTAL CLINIC
EAGLE BUTTE, SD 57625

33aNPI1851422596assigned 03/07/2007

33bProvider typePublic Health Dentist

28Total paid$1.60M

24GClaims7,435

24DCodes billed16

24AFirst – last monthJan 2018 – Oct 2024

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	993	$149K
2019	909	$179K
2020	252	$50K
2021	393	$99K
2022	845	$133K
2023	1,987	$489K
2024incomplete	2,056	$505K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D0140	Limited oral evaluation - problem focused	49%	2,161	2,095	$789K
D1206	Topical application of fluoride varnish	13%	1,584	1,530	$215K
D1110	Prophylaxis - adult	10.0%	580	564	$160K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	8.6%	1,132	1,103	$137K
D1120	Dental cleaning, childProphylaxis - child	5.6%	237	237	$90K
D0330	Panoramic radiographic image	5.4%	537	526	$87K
D0274	Bitewings - four radiographic images	4.0%	248	245	$64K
D0220	Intraoral - periapical first radiographic image	1.2%	155	154	$20K
D7140	Extraction, erupted tooth or exposed root	1.1%	116	83	$18K
D1351	Sealant - per tooth	<1%	205	32	$8K
D0210	Intraoral - complete series of radiographic images	<1%	38	38	$4K
D0603		<1%	240	227	$3K

4 more codes

D2391	Resin-based composite - one surface, posterior, primary or permanent	<1%	19	$3K
D0150	Comprehensive oral evaluation - new or established patient	<1%	79	$2K
D1208	Topical application of fluoride, excluding varnish	<1%	49	$1K
D0602		<1%	55	$455.00

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 officialLARSON, TIFFANY (CRST DENTAL ADMINISTRATIVE MANAGER)

Same official

Other billing entities under LARSON, TIFFANY

Full network →

Provider	Location	Paid
Be Thou My Vision, PLLC	Oakes, ND	$3K

Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.