Dental
Kwon, Sam
Kwon, Sam was paid $187K by Medicaid between Jan 2018 and Jul 2018, across 18 billing codes. Its largest line is D1120, dental cleaning, child — 16% of everything it billed.
33Billing provider infoKWON, SAM
DACULA, GA 30019
DACULA, GA 30019
33aNPI1013054402assigned 02/01/2007
33bProvider typePediatric Dentist
28Total paid$187K
24GClaims8,956
24DCodes billed18
24AFirst – last monthJan 2018 – Jul 2018
Compared with peers
Next to other Pediatric Dentist providers in Georgia
Rank by total paid#13 of 38
Median peer was paid$58K
This provider vs. median3.2×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
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 | 8,956 | $187K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 16% | 1,130 | 1,130 | $29K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 12% | 1,252 | 1,252 | $23K |
| D9630 | 8.7% | 571 | 571 | $16K | |
| D1208 | Topical application of fluoride, excluding varnish | 8.5% | 1,110 | 1,110 | $16K |
| D0272 | Bitewings - two radiographic images | 7.5% | 792 | 792 | $14K |
| D0220 | Intraoral - periapical first radiographic image | 6.9% | 1,188 | 1,186 | $13K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 6.2% | 204 | 101 | $12K |
| D0230 | Intraoral - periapical each additional radiographic image | 5.1% | 1,140 | 1,140 | $10K |
| D1351 | Sealant - per tooth | 4.9% | 400 | 122 | $9K |
| D0274 | Bitewings - four radiographic images | 4.8% | 335 | 335 | $9K |
| D0210 | Intraoral - complete series of radiographic images | 4.5% | 158 | 158 | $8K |
| D1110 | Prophylaxis - adult | 3.5% | 252 | 252 | $7K |
6 more codes
| D9999 | Unspecified adjunctive procedure, by report | 3.2% | 12 | $6K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 2.6% | 41 | $5K |
| D0150 | Comprehensive oral evaluation - new or established patient | 2.2% | 167 | $4K |
| D7140 | Extraction, erupted tooth or exposed root | 2.1% | 76 | $4K |
| D0140 | Limited oral evaluation - problem focused | <1% | 96 | $2K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | <1% | 32 | $612.78 |
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.