CHEYENNE RIVER DENTAL CLINIC
NPI: 1851422596
· EAGLE BUTTE, SD 57625
· Public Health Dentist
· NPI assigned 03/07/2007
Deactivated NPI
· This NPI was deactivated on 07/17/2007. Reactivated 07/18/2007.
$1.60M
Total Medicaid Paid
Provider Details
| Authorized Official | LARSON, TIFFANY (CRST DENTAL ADMINISTRATIVE MANAGER) |
| NPI Enumeration Date | 03/07/2007 |
Related Entities
Other providers sharing the same authorized official: LARSON, TIFFANY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
993 |
$149K |
| 2019 |
909 |
$179K |
| 2020 |
252 |
$50K |
| 2021 |
393 |
$99K |
| 2022 |
845 |
$133K |
| 2023 |
1,987 |
$489K |
| 2024 |
2,056 |
$505K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,161 |
2,095 |
$789K |
| D1206 |
Topical application of fluoride varnish |
1,584 |
1,530 |
$215K |
| D1110 |
Prophylaxis - adult |
580 |
564 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
1,132 |
1,103 |
$137K |
| D1120 |
Prophylaxis - child |
237 |
237 |
$90K |
| D0330 |
Panoramic radiographic image |
537 |
526 |
$87K |
| D0274 |
Bitewings - four radiographic images |
248 |
245 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
155 |
154 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
116 |
83 |
$18K |
| D1351 |
Sealant - per tooth |
205 |
32 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
38 |
$4K |
| D0603 |
|
240 |
227 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
79 |
79 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
49 |
49 |
$1K |
| D0602 |
|
55 |
55 |
$455.00 |