1013192657

1013192657 was paid $1.28M by Medicaid between Jan 2018 and Jul 2022, across 23 billing codes. Its largest line is D2391, Resin-based composite - one surface, posterior, primary or permanent — 18% of everything it billed.

33Billing provider info1013192657

33aNPI1013192657

33bProvider type—

28Total paid$1.28M

24GClaims41,231

24DCodes billed23

24AFirst – last monthJan 2018 – Jul 2022

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	10,964	$308K
2019	9,948	$285K
2020	8,508	$279K
2021	8,066	$280K
2022	3,745	$127K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D2391	Resin-based composite - one surface, posterior, primary or permanent	18%	5,004	1,535	$230K
D2335		11%	1,540	519	$145K
D1110	Prophylaxis - adult	11%	4,078	4,041	$135K
D7140	Extraction, erupted tooth or exposed root	7.7%	1,785	852	$98K
D0330	Panoramic radiographic image	7.1%	2,053	2,044	$91K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	6.4%	4,893	4,849	$81K
D1351	Sealant - per tooth	5.8%	3,662	777	$75K
D2161		5.4%	940	723	$69K
D0274	Bitewings - four radiographic images	4.5%	2,962	2,926	$57K
D0150	Comprehensive oral evaluation - new or established patient	4.3%	2,107	2,087	$54K
D2140		3.8%	1,244	426	$49K
D1120	Dental cleaning, childProphylaxis - child	3.4%	2,245	2,227	$43K

11 more codes

D1208	Topical application of fluoride, excluding varnish	3.3%	2,860	$42K
D2394		2.4%	421	$30K
D0140	Limited oral evaluation - problem focused	2.3%	1,348	$30K
D4341		1.0%	143	$13K
D0272	Bitewings - two radiographic images	<1%	945	$9K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	<1%	145	$8K
D0220	Intraoral - periapical first radiographic image	<1%	1,637	$8K
D0230	Intraoral - periapical each additional radiographic image	<1%	1,066	$5K
D0210	Intraoral - complete series of radiographic images	<1%	76	$4K
D2150	Silver amalgam - two surfaces, primary or permanent	<1%	48	$2K
D1330		0%	29	$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.