Dental
Ikdo State Street LLC
Ikdo State Street LLC was paid $107K by Medicaid between Jul 2019 and Sep 2022, across 15 billing codes. Its largest line is D1120, dental cleaning, child — 39% of everything it billed.
33Billing provider infoIKDO STATE STREET LLC
GARDEN CITY, ID 83714
GARDEN CITY, ID 83714
33aNPI1932683752assigned 09/18/2018
33bProvider typePediatric Dentist
28Total paid$107K
24GClaims5,678
24DCodes billed15
24AFirst – last monthJul 2019 – Sep 2022
Compared with peers
Next to other Pediatric Dentist providers in Idaho
Rank by total paid#40 of 53
Median peer was paid$394K
This provider vs. median0.3×
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 | |
|---|---|---|---|
| 2019 | 210 | $2K | |
| 2020 | 1,267 | $24K | |
| 2021 | 3,102 | $62K | |
| 2022 | 1,099 | $19K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 39% | 1,029 | 1,027 | $42K |
| D0330 | Panoramic radiographic image | 18% | 243 | 243 | $19K |
| D0150 | Comprehensive oral evaluation - new or established patient | 14% | 499 | 499 | $15K |
| D1110 | Prophylaxis - adult | 13% | 216 | 214 | $14K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 12% | 152 | 98 | $12K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 2.1% | 36 | 28 | $2K |
| D0210 | Intraoral - complete series of radiographic images | 1.8% | 15 | 15 | $2K |
| D1351 | Sealant - per tooth | <1% | 69 | 12 | $312.45 |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | <1% | 699 | 696 | $196.28 |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | <1% | 361 | 326 | $96.54 |
| D0272 | Bitewings - two radiographic images | <1% | 812 | 812 | $15.87 |
| D1208 | Topical application of fluoride, excluding varnish | <1% | 1,203 | 1,200 | $13.55 |
3 more codes
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 officialBIRCH, JAYCIE (OFFICE MANAGER)