Based on public Medicaid payment data.
Jordan Dietrich
Medicaid Provider in Wautoma, WI
Type
Individual Provider
Address
400 S Townline Rd
Wautoma, WI 549826922
Phone
9207875514
NPI
1902582604
Procedures
3
Total Claims
3.4K
Patients Served
2.7K
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 | $0.00 | 1,528 | 1,470 |
| Dental Filling | $0.00 | 1,313 | 952 |
| Tooth Extraction | $0.00 | 525 | 231 |
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