1003170432

1003170432 was paid $817K by Medicaid between Jan 2018 and Aug 2020, across 23 billing codes. Its largest line is D2752, — 29% of everything it billed.

33Billing provider info1003170432

33aNPI1003170432

33bProvider type—

28Total paid$817K

24GClaims19,161

24DCodes billed23

24AFirst – last monthJan 2018 – Aug 2020

Box 24A · Dates of service

Paid by month

Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider

By year, as a table

Year	Claims	Paid
2018	7,189	$295K
2019	9,148	$425K
2020	2,824	$97K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D2752		29%	526	338	$235K
D1351	Sealant - per tooth	17%	6,114	899	$136K
D3330	Endodontic therapy, molar tooth (excluding final restoration)	8.7%	218	189	$71K
D2954		7.4%	539	348	$60K
D2391	Resin-based composite - one surface, posterior, primary or permanent	6.7%	814	409	$55K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	5.5%	701	361	$45K
D0150	Comprehensive oral evaluation - new or established patient	3.4%	1,005	975	$28K
D0330	Panoramic radiographic image	3.0%	935	908	$25K
D1120	Dental cleaning, childProphylaxis - child	2.7%	891	867	$22K
D1208	Topical application of fluoride, excluding varnish	2.4%	1,173	1,144	$19K
D0220	Intraoral - periapical first radiographic image	2.4%	2,316	1,514	$19K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	2.0%	841	821	$17K

11 more codes

D0274	Bitewings - four radiographic images	1.7%	509	$14K
D2330		1.6%	214	$13K
D0272	Bitewings - two radiographic images	1.5%	661	$12K
D7140	Extraction, erupted tooth or exposed root	1.5%	160	$12K
D1110	Prophylaxis - adult	1.5%	356	$12K
D0230	Intraoral - periapical each additional radiographic image	<1%	745	$6K
D3310		<1%	23	$6K
D0140	Limited oral evaluation - problem focused	<1%	122	$4K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	<1%	163	$3K
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	<1%	26	$2K
D0364		0%	109	$0.00

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.