Clinic
Cache Valley Pediatric Dentistry
Cache Valley Pediatric Dentistry was paid $10K by Medicaid between Nov 2023 and Dec 2024, across 6 billing codes. Its largest line is D1110, Prophylaxis - adult — 70% of everything it billed.
33Billing provider infoCACHE VALLEY PEDIATRIC DENTISTRY
LOGAN, UT 84341
LOGAN, UT 84341
33aNPI1962282459assigned 10/02/2023
33bProvider typeDental Clinic/Center
28Total paid$10K
24GClaims665
24DCodes billed6
24AFirst – last monthNov 2023 – Dec 2024
Compared with peers
Next to other Dental Clinic/Center providers in Utah
Rank by total paid#29 of 37
Median peer was paid$90K
This provider vs. median0.1×
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 | |
|---|---|---|---|
| 2023 | 40 | $35.37 | |
| 2024incomplete | 625 | $10K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 70% | 87 | 87 | $7K |
| D1120 | Dental cleaning, childProphylaxis - child | 27% | 57 | 57 | $3K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 2.8% | 278 | 276 | $284.74 |
| D1206 | Topical application of fluoride varnish | 0% | 212 | 212 | $0.00 |
| D0272 | Bitewings - two radiographic images | 0% | 17 | 17 | $0.00 |
| D0274 | Bitewings - four radiographic images | 0% | 14 | 14 | $0.00 |
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 officialGIBBS, TORI (OFFICE MANAGER)