Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › NE › LINCOLN › SOUTH LINCOLN DENTAL LLC

SOUTH LINCOLN DENTAL LLC

NPI: 1922525450 · LINCOLN, NE 68510 · General Practice Dentistry · NPI assigned 08/25/2017

$3K
Total Medicaid Paid
146
Total Claims
146
Beneficiaries
4
Codes Billed
2018-10
First Month
2019-10
Last Month

Provider Details

Authorized OfficialGALL, BONNIE (CLINICAL COORDINATOR)
Parent OrganizationSOUTH LINCOLN DENTAL LLC
NPI Enumeration Date08/25/2017

Related Entities

Other providers sharing the same authorized official: GALL, BONNIE

ProviderCityStateTotal Paid
CRETE FAMILY DENTAL, LLC CRETE NE $51K
NORTHEAST FAMILY DENTAL LLC LINCOLN NE $10K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 15 $308.00
2019 131 $3K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D1206 Topical application of fluoride varnish 55 55 $1K
D0120 Periodic oral evaluation - established patient 52 52 $1K
D0150 Comprehensive oral evaluation - new or established patient 27 27 $572.00
D1110 Prophylaxis - adult 12 12 $403.92