BONANZA DENTAL PARTNERS SOS Verified
556 N EASTERN AVE STE I, LAS VEGAS, NV 89101
NPI Number
1114432531
Practice location · View on Google Maps
SOS Verification: Verified
Entity Name: BONANZA DENTAL PARTNERS LLC
Entity Number: E0267202017-8
Entity Type: Domestic Limited-Liability Company
Entity Status: Active
Formation Date: 2017-06-05
Name Match: 90%
Registered Agent
Name: WYATT STOTT DANNELS
Type: Non-Commercial Registered Agent
Address: 612 CHERVIL VALLEY DR, LAS VEGAS, NV, 89138
Officers / Principals
| Title | Name | Address | Status |
|---|---|---|---|
| Mmember | WYATT DANNELS | 556 N EASTERN AVE, STE I, LAS VEGAS, NV, 89101 | Active |
| Other | YOUSSEF SALLOUM | 556 N EASTERN AVE, STE I, Las Vegas, NV | Active |
Total Medicaid Payments
$29,542
-92% vs specialty average
Patients Seen
1,047
Total Claims
1,233
$ Per Patient
$28
Specialty avg: $34
Specialty Rank
#119 of 180
Dentist providers in Nevada
Peer Average
$355,999
Average total for Dentist
Claims per Patient
1.2
Average visits / services per person
Payments by Year
How much Medicaid paid this provider each year. Large jumps can indicate changes in practice volume or billing patterns.
| Year | Total Paid | % of Max |
|---|---|---|
| 2023 | $1,213 | |
| 2024 | $28,329 |
Procedure Code Breakdown
The specific medical services this provider billed Medicaid for. Each HCPCS/CPT code represents a different type of visit, test, or treatment.
| HCPCS Code | Description | Claims | Paid | % of Total | Avg per Claim |
|---|---|---|---|---|---|
| D0210 | Full set of dental X-rays | 132 | $6,930 | 23.5% | $53 |
| D0150 | Comprehensive dental exam — thorough check of teeth, gums, and mouth | 238 | $6,116 | 20.7% | $26 |
| D0274 | Dental X-ray — bitewings (four films) | 146 | $3,323 | 11.2% | $23 |
| D0220 | Single dental X-ray (of one tooth) | 213 | $2,918 | 9.9% | $14 |
| D7210 | Surgical tooth extraction — requires cutting into gum or removing bone | 51 | $2,196 | 7.4% | $43 |
| D1351 | Dental sealant — protective coating on a tooth to prevent cavities | 95 | $2,079 | 7.0% | $22 |
| D0330 | Panoramic dental X-ray (full view of all teeth and jaw) | 48 | $1,798 | 6.1% | $37 |
| D2391 | Tooth-colored (resin) filling — one surface, back tooth | 42 | $1,427 | 4.8% | $34 |
| D0230 | Additional dental X-ray | 198 | $1,177 | 4.0% | $6 |
| D1120 | Dental cleaning for children (prophylaxis) | 13 | $722 | 2.4% | $56 |
| D1206 | Fluoride treatment — painted on teeth to prevent cavities | 15 | $598 | 2.0% | $40 |
| D0120 | Regular dental checkup and exam | 20 | $257 | 0.9% | $13 |
| D9920 | Other dental service | 22 | $0 | 0.0% | $0 |
About This Data
This data comes from the HHS Medicaid Provider Spending dataset (opendata.hhs.gov). It shows payments made through Nevada Medicaid from 2018–2024. High payments do not mean a provider is doing anything wrong — some specialties naturally cost more, and busy providers see more patients. But unusually high numbers compared to peers can be worth a closer look.