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    OpenPayerNPI Medicare & MedicaidDental Depot Of Broken Arrow, PLLC
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    Dental Depot Of Broken Arrow, PLLC — Billing Profile & Reimbursement Data

    NPI 1780001636 · Broken Arrow, OK · Dentist

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    Dental Depot Of Broken Arrow, PLLC is a dentist provider located in Broken Arrow, 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 Of Broken Arrow, PLLC
    Address1950 W Kenosha St
    CityBroken Arrow
    StateOK
    ZIP74012
    TaxonomyDentist
    NPI EnumeratedMarch 27, 2014

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

    Payer SourceTotal Paid
    Medicaid$3.2M
    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…3,960$130$498.3K
    D2393Resin-based composite, three surfaces, posterior2,690$160$416.6K
    D0330N/A5,750$50$275.8K
    D0274N/A8,970$30$269.1K
    D2392Post 2 surface resin‑based composite2,480$110$264.9K
    D1110Prophylaxis - adult; cleaning and polishing of the teeth5,830$50$262.3K
    D0220Intraoral - periapical first radiographic image16,580$20$248.6K
    D1120Prophylaxis–child5,270$30$158.1K
    D0230Intraoral - periapical each additional radiographic image19,690$10$157.5K
    D0150Comprehensive oral evaluation – new or established patient5,180$30$155.3K

    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…21180450$120$188.3K
    D2392Post 2 surface resin‑based composite56330530$100$162.1K
    D2393Resin-based composite, three surfaces, posterior17190300$140$128.6K
    D1120Prophylaxis–child53470730$30$77.5K
    D0120Periodic oral evaluation - established patient55540910$20$61.2K
    D1110Prophylaxis - adult; cleaning and polishing of the teeth26480530$40$57.4K
    D0330N/A16420360$50$49.5K
    D1206Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients403801,000$20$45.7K
    D2391Resin‑based composite – one surface, posterior182250230$60$43.4K
    D0274N/A9420520$30$37K

    Showing 1–10 of 24

    Related Providers

    Other providers that share a Tax Identification Number (TIN) with Dental Depot Of Broken Arrow, PLLC, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Ray TateOKGeneral Practice Dentistry$14.2K$0

    Nearby Providers

    Other providers in the same ZIP code as Dental Depot Of Broken Arrow, PLLC, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Collaborative Therapy Services IncOKMulti-Specialty Clinic/Center$0$12.9M
    Family Smiles Dentistry, PLLCOKGeneral Practice Dentistry$0$10.8M
    Eastern Oklahoma Oral And Maxillofacial SurgeonsOKOral and Maxillofacial Surgery (Dentist)$0$8.3M
    Stonewood Hills Oral Maxillofacial Surgery, Inc.OKOral and Maxillofacial Surgery (Dentist)$0$6.5M
    Eton Home Healthcare, Inc.OKHome Health Agency$0$5.6M
    Brighter Dimensions, LLCOKCommunity/Behavioral Health Agency$0$5M
    City Of Broken ArrowOKLand Ambulance$1.2M$2.4M
    The Griffin PromiseOKSpeech-Language Pathologist$0$3.2M
    Pmo Medical PLLCOKPain Medicine (Physical Medicine & Rehabilitation) Physician$0$3.1M
    Wellspring Family ClinicOKClinic/Center$0$2.9M

    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 Of Broken Arrow, PLLC — 5 of 24 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Oklahoma