Dental
Lakeside Pediatric Dental Specialists
Lakeside Pediatric Dental Specialists was paid $2.07M by Medicaid between Oct 2020 and Dec 2024, across 18 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 24% of everything it billed.
33Billing provider infoLAKESIDE PEDIATRIC DENTAL SPECIALISTS
PORT HURON, MI 48060
PORT HURON, MI 48060
33aNPI1891194379assigned 08/20/2014
33bProvider typePediatric Dentist
28Total paid$2.07M
24GClaims38,917
24DCodes billed18
24AFirst – last monthOct 2020 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Michigan
Rank by total paid#34 of 153
Median peer was paid$464K
This provider vs. median4.4×
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 | |
|---|---|---|---|
| 2020 | 1,985 | $116K | |
| 2021 | 9,726 | $534K | |
| 2022 | 8,937 | $449K | |
| 2023 | 10,064 | $522K | |
| 2024incomplete | 8,205 | $443K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 24% | 2,663 | 1,250 | $489K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 17% | 3,034 | 1,465 | $352K |
| D1120 | Dental cleaning, childProphylaxis - child | 12% | 6,094 | 6,093 | $244K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 9.7% | 6,201 | 6,200 | $199K |
| D1206 | Topical application of fluoride varnish | 8.2% | 6,380 | 6,379 | $168K |
| D7140 | Extraction, erupted tooth or exposed root | 6.7% | 1,708 | 913 | $138K |
| D0140 | Limited oral evaluation - problem focused | 5.1% | 1,804 | 1,793 | $106K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 4.6% | 1,100 | 750 | $94K |
| D0272 | Bitewings - two radiographic images | 3.0% | 2,618 | 2,618 | $63K |
| D1351 | Sealant - per tooth | 2.9% | 2,024 | 799 | $61K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 2.1% | 366 | 247 | $43K |
| D0220 | Intraoral - periapical first radiographic image | 1.5% | 1,774 | 1,757 | $31K |
6 more codes
| D0230 | Intraoral - periapical each additional radiographic image | 1.4% | 2,217 | $29K |
| D1110 | Prophylaxis - adult | <1% | 337 | $16K |
| D0330 | Panoramic radiographic image | <1% | 174 | $12K |
| D0274 | Bitewings - four radiographic images | <1% | 272 | $9K |
| D9248 | <1% | 96 | $6K | |
| D0150 | Comprehensive oral evaluation - new or established patient | <1% | 55 | $3K |
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 officialMONROY, PHILLIP (OWNER)