Dental
State Avenue Dental LLC
State Avenue Dental LLC was paid $1.88M by Medicaid between Jan 2018 and Nov 2024, across 23 billing codes. Its largest line is D7210, Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth — 17% of everything it billed.
33Billing provider infoSTATE AVENUE DENTAL LLC
KANSAS CITY, KS 66112
KANSAS CITY, KS 66112
33aNPI1881959278assigned 07/11/2012
33bProvider typeDentist
28Total paid$1.88M
24GClaims58,942
24DCodes billed23
24AFirst – last monthJan 2018 – Nov 2024
Compared with peers
Next to other Dentist providers in Kansas
Rank by total paid#7 of 112
Median peer was paid$52K
This provider vs. median36×
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 | 4,541 | $134K | |
| 2019 | 9,654 | $283K | |
| 2020 | 8,074 | $207K | |
| 2021 | 8,361 | $297K | |
| 2022 | 10,439 | $336K | |
| 2023 | 10,975 | $399K | |
| 2024incomplete | 6,898 | $229K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | 17% | 2,968 | 1,369 | $325K |
| D1351 | Sealant - per tooth | 17% | 13,082 | 1,460 | $323K |
| D1110 | Prophylaxis - adult | 9.5% | 4,460 | 4,302 | $179K |
| D0274 | Bitewings - four radiographic images | 7.5% | 5,089 | 4,906 | $142K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 7.0% | 1,790 | 953 | $132K |
| D0140 | Limited oral evaluation - problem focused | 7.0% | 4,768 | 4,416 | $132K |
| D0150 | Comprehensive oral evaluation - new or established patient | 6.1% | 4,032 | 3,909 | $115K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 5.6% | 5,165 | 4,967 | $106K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 4.1% | 1,097 | 510 | $77K |
| D0210 | Intraoral - complete series of radiographic images | 3.9% | 1,372 | 1,328 | $73K |
| D0220 | Intraoral - periapical first radiographic image | 3.6% | 5,842 | 5,461 | $68K |
| D1208 | Topical application of fluoride, excluding varnish | 2.7% | 2,897 | 2,807 | $50K |
11 more codes
| D1120 | Dental cleaning, child | 2.5% | 1,764 | $47K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 1.9% | 441 | $36K |
| D0230 | Intraoral - periapical each additional radiographic image | 1.1% | 2,261 | $22K |
| D7140 | Extraction, erupted tooth or exposed root | <1% | 168 | $13K |
| D2394 | <1% | 113 | $11K | |
| D0330 | Panoramic radiographic image | <1% | 410 | $10K |
| D2335 | <1% | 85 | $9K | |
| D1206 | Topical application of fluoride varnish | <1% | 300 | $5K |
| D0270 | <1% | 282 | $4K | |
| D0240 | <1% | 194 | $3K | |
| D1999 | <1% | 362 | $10.00 |
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 officialTINGEY, MATTHEW (DENTIST)