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    OpenPayerNPI Medicare & MedicaidSummit Dental Health - Brentwood LLC
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    Summit Dental Health - Brentwood LLC — Billing Profile & Reimbursement Data

    NPI 1154739613 · La Vista, NE · General Practice Dentistry

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    Summit Dental Health - Brentwood LLC is a general practice dentistry provider located in La Vista, Nebraska. This profile covers 0 Medicare and 19 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeOrganization
    OrganizationSummit Dental Health - Brentwood LLC
    Address8041 S 83rd Ave
    CityLa Vista
    StateNE
    ZIP68128
    TaxonomyGeneral Practice Dentistry
    NPI EnumeratedJuly 29, 2014

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicaid$1.8M
    Medicare$0

    Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

    Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.

    View: By Year1 / 3

    Medicaid: Complete Services Breakdown

    Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

    19 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    D2392Post 2 surface resin‑based composite2,300$140$310.2K
    D1206Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients6,620$30$224.9K
    D0210Intraoral - complete series of radiographic images2,670$80$213.2K
    D1110Prophylaxis - adult; cleaning and polishing of the teeth3,840$50$207.3K
    D0120Periodic oral evaluation - established patient4,840$40$169.4K
    D0274N/A6,530$20$124.1K
    D0150Comprehensive oral evaluation – new or established patient3,160$40$117K
    D1120Prophylaxis–child2,240$40$87.3K
    D2391Resin‑based composite – one surface, posterior640$110$70.9K
    D0220Intraoral - periapical first radiographic image9,570$10$57.4K

    Showing 1–10 of 19

    Medicaid: Competitive Analysis & Benchmarks

    How this provider's Medicaid billing volume and revenue compare to other Nebraska providers billing the same CPT/HCPCS codes.

    Full comparison — all codes billed, vs. Nebraska median

    19 rows

    CPT/HCPCS CodeDescriptionRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    D1351Sealant - per tooth86130460$30$84.7K
    D2392Post 2 surface resin‑based composite16140270$80$66.8K
    D1206Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients34320460$20$62.2K
    D1120Prophylaxis–child48290320$30$61K
    D0120Periodic oral evaluation - established patient38400430$20$44.3K
    D2391Resin‑based composite – one surface, posterior34120150$60$33.1K
    D9230N/A7990260$30$32.2K
    D1110Prophylaxis - adult; cleaning and polishing of the teeth13310220$40$28.1K
    D0210Intraoral - complete series of radiographic images6130160$50$26.8K
    D2393Resin-based composite, three surfaces, posterior1750110$100$21.4K

    Showing 1–10 of 19

    Nearby Providers

    Other providers in the same ZIP code as Summit Dental Health - Brentwood LLC, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Optum Infusion Services 302, LLCNEHome Infusion Therapy Pharmacy$26.6K$1.9M
    Gregory WeederNEPediatric Dentistry$0$1.1M
    Focus C3, PCNEMental Health Counselor$0$608.9K
    Nicholas Snyder, D.c., P.C.NEChiropractor$0$302.9K
    Brittany Schuller HarveyNEMental Health Counselor$0$301.2K
    Meylor Chiropractic And Acupuncture PCNEIndependent Medical Examiner Chiropractor$0$269.2K
    Lifecare Family Medicine Of Bellevue, P.C.NEFamily Medicine Physician$0$213.2K
    Christine InguanzoNEFamily Medicine Physician$131.5K$0
    Your Hometown Pharmacy IncNELong Term Care Pharmacy$85.6K$160

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicaid Revenue by Year vs. Nebraska Providers
    0 of 7 years billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Claims Volume vs. Nebraska Distribution
    Summit Dental Health - Brentwood LLC — 6 of 19 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Nebraska