PALMETTO SMILES DENTISTRY PARTNERSHIP
NPI: 1922214766
· LEXINGTON, SC 29072
· Pediatric Dentist
· NPI assigned 05/16/2007
$559K
Total Medicaid Paid
Provider Details
| Authorized Official | RAINES, KEVIN (PARTNER) |
| NPI Enumeration Date | 05/16/2007 |
Related Entities
Other providers sharing the same authorized official: RAINES, KEVIN
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
3,705 |
$97K |
| 2019 |
3,408 |
$86K |
| 2020 |
2,494 |
$61K |
| 2021 |
3,384 |
$85K |
| 2022 |
3,408 |
$88K |
| 2023 |
2,988 |
$75K |
| 2024 |
2,586 |
$67K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,993 |
5,993 |
$134K |
| D1110 |
Prophylaxis - adult |
2,656 |
2,656 |
$126K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,300 |
6,300 |
$102K |
| D1120 |
Prophylaxis - child |
2,673 |
2,673 |
$90K |
| D0272 |
Bitewings - two radiographic images |
2,617 |
2,617 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,553 |
1,533 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
53 |
36 |
$5K |
| D9248 |
|
63 |
63 |
$4K |
| D1351 |
Sealant - per tooth |
40 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$1K |