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    OpenPayerNPI Medicare & MedicaidDental Depot South
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    Dental Depot South — Billing Profile & Reimbursement Data

    NPI 1578768180 · Oklahoma City, OK · General Practice Dentistry

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    Dental Depot South is a general practice dentistry provider located in Oklahoma City, Oklahoma. This profile covers 0 Medicare and 24 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
    OrganizationDental Depot South
    Address1024 Sw 104th St
    CityOklahoma City
    StateOK
    ZIP73139
    TaxonomyGeneral Practice Dentistry
    NPI EnumeratedJune 15, 2007

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

    Payer SourceTotal Paid
    Medicaid$3.4M
    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.

    24 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    D7210Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation; includes related cutting of gingiva and bone, removal of tooth structure, minor smoothing of…4,290$120$514.3K
    D2392Post 2 surface resin‑based composite3,510$110$389.1K
    D0274N/A10,020$30$300.6K
    D1110Prophylaxis - adult; cleaning and polishing of the teeth6,720$40$295.9K
    D0220Intraoral - periapical first radiographic image17,920$20$268.9K
    D0330N/A5,620$50$263.9K
    D2393Resin-based composite, three surfaces, posterior1,740$140$240K
    D0120Periodic oral evaluation - established patient10,960$20$230.2K
    D1120Prophylaxis–child7,130$30$213.8K
    D0230Intraoral - periapical each additional radiographic image19,750$10$138.3K

    Showing 1–10 of 24

    Medicaid: Competitive Analysis & Benchmarks

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

    Full comparison — all codes billed, vs. Oklahoma median

    24 rows

    CPT/HCPCS CodeDescriptionRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    D7210Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation; includes related cutting of gingiva and bone, removal of tooth structure, minor smoothing of…20180450$120$188.3K
    D7230N/A1120170$170$163.1K
    D2392Post 2 surface resin‑based composite33330530$100$162.1K
    D2393Resin-based composite, three surfaces, posterior29190300$140$128.6K
    D7140Extraction, erupted tooth or exposed root (elevation and/or forceps removal)137240280$70$91.8K
    D1120Prophylaxis–child39470730$30$77.5K
    D0120Periodic oral evaluation - established patient35540910$20$61.2K
    D1110Prophylaxis - adult; cleaning and polishing of the teeth16480530$40$57.4K
    D7310N/A1410160$140$51.7K
    D0330N/A17420360$50$49.5K

    Showing 1–10 of 24

    Nearby Providers

    Other providers in the same ZIP code as Dental Depot South, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Variety Care, Inc.OKFederally Qualified Health Center (FQHC)$0$53.3M
    Ace Hts, IncOKDevelopmentally Disabled Services Day Training Agency$0$29.9M
    Hope Community Services, Inc.OKCommunity/Behavioral Health Agency$0$16.1M
    Oklahoma Mental Health CouncilOKCommunity/Behavioral Health Agency$0$5M
    New Life Youth's & Family Counseling Services, IncOKCommunity/Behavioral Health Agency$0$3.5M
    Dental Depot 62nd & South Western PLLCOKGeneral Practice Dentistry$0$3.5M
    Osu Center For Health SciencesOKClinic/Center$0$3.1M
    Oklahoma Center For Orthopaedic & Multi-specialty Surgery, LLCOKGeneral Acute Care Hospital$0$2.8M
    Empowerment Community ServicesOKCommunity/Behavioral Health Agency$0$2.6M
    Dental Depot Orthodontics South PLLCOKOrthodontics and Dentofacial Orthopedics Dentistry$0$2.5M

    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. Oklahoma Providers
    0 of 4 years billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Claims Volume vs. Oklahoma Distribution
    Dental Depot South — 6 of 24 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Oklahoma