AQUA DENTAL GROUP LLC SOS Verified
2500 WIGWAM PKWY STE 110, HENDERSON, NV 89074
NPI Number
1518523729
Practice location · View on Google Maps
SOS Verification: Verified
Entity Name: AQUA DENTAL GROUP LLC
Entity Number: E0205122019-6
Entity Type: Domestic Limited-Liability Company
Entity Status: Active
Formation Date: 2019-05-02
Name Match: 95%
Registered Agent
Name: LEILA KHOSSOOSI
Type: Non-Commercial Registered Agent
Address: 2285 E. FLAMINGO ROAD #101, LAS VEGAS, NV, 89119
Officers / Principals
| Title | Name | Address | Status |
|---|---|---|---|
| Manager | LEILA KHOSSOOSI | 2285 E. FLAMINGO ROAD #101, LAS VEGAS, NV, 89119 | Active |
| Manager | MOHAMMAD KHOSOUSI | 2285 E. FLAMINGO ROAD #101, LAS VEGAS, NV, 89119 | Active |
Total Medicaid Payments
$357,788
-28% vs specialty average
Patients Seen
11,186
Total Claims
12,178
$ Per Patient
$32
Specialty avg: $33
Specialty Rank
#10 of 36
Clinic/Center, Dental providers in Nevada
Peer Average
$498,808
Average total for Clinic/Center, Dental
Claims per Patient
1.1
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 |
|---|---|---|
| 2019 | $1,957 | |
| 2020 | $57,787 | |
| 2021 | $81,405 | |
| 2022 | $82,492 | |
| 2023 | $80,425 | |
| 2024 | $53,722 |
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 |
|---|---|---|---|---|---|
| D0140 | Limited dental exam — for a specific problem (like a toothache) | 1,941 | $62,739 | 17.5% | $32 |
| D0210 | Full set of dental X-rays | 820 | $47,184 | 13.2% | $58 |
| D0330 | Panoramic dental X-ray (full view of all teeth and jaw) | 930 | $36,311 | 10.1% | $39 |
| D0274 | Dental X-ray — bitewings (four films) | 1,482 | $33,428 | 9.3% | $23 |
| D0230 | Additional dental X-ray | 2,244 | $32,797 | 9.2% | $15 |
| D0220 | Single dental X-ray (of one tooth) | 1,825 | $32,026 | 9.0% | $18 |
| D1206 | Fluoride treatment — painted on teeth to prevent cavities | 515 | $25,971 | 7.3% | $50 |
| D1120 | Dental cleaning for children (prophylaxis) | 411 | $22,800 | 6.4% | $55 |
| D7210 | Surgical tooth extraction — requires cutting into gum or removing bone | 260 | $19,345 | 5.4% | $74 |
| D0150 | Comprehensive dental exam — thorough check of teeth, gums, and mouth | 521 | $15,564 | 4.4% | $30 |
| D0120 | Regular dental checkup and exam | 471 | $12,000 | 3.4% | $25 |
| D1351 | Dental sealant — protective coating on a tooth to prevent cavities | 433 | $10,378 | 2.9% | $24 |
| D1110 | Dental cleaning for adults (prophylaxis) | 267 | $5,416 | 1.5% | $20 |
| D2950 | Crown buildup — rebuilding a broken tooth so a crown can be placed | 34 | $1,722 | 0.5% | $51 |
| D0603 | Dental exam, X-ray, or screening | 12 | $63 | 0.0% | $5 |
| D0601 | Dental exam, X-ray, or screening | 12 | $45 | 0.0% | $4 |
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.