SOUTH DELTA DENTAL CLINIC, LLC
NPI: 1902162811
· ROLLING FORK, MS 39159
· General Practice Dentistry
· NPI assigned 04/04/2012
Billing Flags
· Automated signals — not evidence of fraud
Entity Proliferation
Authorized official MURPHY, MICHAEL controls 14+ related entities in our dataset. Read more
$276K
Total Medicaid Paid
Provider Details
| Authorized Official | MURPHY, MICHAEL (CHIEF OPERATING OFFICER) |
| NPI Enumeration Date | 04/04/2012 |
Related Entities
Other providers sharing the same authorized official: MURPHY, MICHAEL
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,679 |
$17K |
| 2019 |
1,704 |
$49K |
| 2020 |
1,074 |
$28K |
| 2021 |
1,972 |
$58K |
| 2022 |
1,987 |
$64K |
| 2023 |
1,021 |
$32K |
| 2024 |
917 |
$29K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,507 |
2,136 |
$65K |
| D1206 |
Topical application of fluoride varnish |
2,504 |
2,148 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,356 |
1,275 |
$36K |
| D0330 |
Panoramic radiographic image |
692 |
643 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,163 |
923 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
880 |
598 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
171 |
94 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
498 |
428 |
$17K |
| D1351 |
Sealant - per tooth |
358 |
77 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
225 |
208 |
$2K |