Divine Dental of Santa Fe

Divine Dental of Santa Fe was paid $59K by Medicaid between Jan 2018 and Jan 2020, across 10 billing codes. Its largest line is D2392, Resin-based composite - two surfaces, posterior, primary or permanent — 22% of everything it billed.

33Billing provider infoDIVINE DENTAL OF SANTA FE
SANTA FE, NM 87505

33aNPI1992904288assigned 07/16/2007

33bProvider typeDentist

28Total paid$59K

24GClaims1,974

24DCodes billed10

24AFirst – last monthJan 2018 – Jan 2020

Compared with peers

Next to other Dentist providers in New Mexico

Rank by total paid#82 of 179

Median peer was paid$47K

This provider vs. median1.3×

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
2018	1,533	$46K
2019	399	$12K
2020	42	$1K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	22%	259	110	$13K
D0274	Bitewings - four radiographic images	16%	370	369	$9K
D1110	Prophylaxis - adult	14%	230	230	$8K
D1208	Topical application of fluoride, excluding varnish	12%	457	457	$7K
D2391	Resin-based composite - one surface, posterior, primary or permanent	12%	160	71	$7K
D0150	Comprehensive oral evaluation - new or established patient	10%	237	236	$6K
D0210	Intraoral - complete series of radiographic images	6.3%	94	94	$4K
D1120	Dental cleaning, childProphylaxis - child	5.2%	99	99	$3K
D0140	Limited oral evaluation - problem focused	1.8%	39	37	$1K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	<1%	29	29	$547.17

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 officialVALDEZ, ESMAEL (CO-OWNER)