Based on public Medicaid payment data.
Derick Jack Sovereign
Medicaid Provider in Wasilla, AK
Type
Individual Provider
Address
3765 E Blue Lupine Dr Ste A
Wasilla, AK 996548417
Phone
4803410791
NPI
1245073287
Procedures
4
Total Claims
476
Patients Served
364
About these costs
All amounts reflect Medicaid reimbursement rates, which are typically much lower than private insurance or cash prices. These figures show what state Medicaid programs actually paid this provider per claim.
Procedures & Average Costs
| Procedure | Avg. Paid | Claims | Patients |
|---|---|---|---|
| Dental Cleaning & Exam | $72.18 | 302 | 294 |
| Dental Filling | $192.74 | 94 | 44 |
| Tooth Extraction | $169.24 | 65 | 13 |
| Dental Crown | $730.25 | 15 | 13 |
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