Medicaid Provider SpendingClaims paid 2018–2024 · HHS public file
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Dental

Rodeo Dental Southmost PLLC

Rodeo Dental Southmost PLLC was paid $8.91M by Medicaid between Jan 2018 and Dec 2024, across 36 billing codes. Its largest line is D2392, Resin-based composite - two surfaces, posterior, primary or permanent — 16% of everything it billed.

33Billing provider infoRODEO DENTAL SOUTHMOST PLLC
BROWNSVILLE, TX 78521
33aNPI1013217579assigned 10/29/2010
33bProvider typePediatric Dentist
28Total paid$8.91M
24GClaims260,825
24DCodes billed36
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers

Next to other Pediatric Dentist providers in Texas

Rank by total paid#8 of 693
Median peer was paid$252K
This provider vs. median35×

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.

Auditor's notes

Automated statistical signals. Not evidence of fraud — how these are computed.

Entity ProliferationAuthorized official KOUYOUMDJIAN, RAFFY controls 19+ related entities in our dataset. Read more
Box 24A · Dates of service

Paid by month

$0$100K$200K$300K2018201920202021202220232024
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
YearClaimsPaid
2018418$5K
2019935$14K
20207,305$272K
202167,475$2.32M
202269,078$2.41M
202366,648$2.28M
2024incomplete48,966$1.61M
Box 24 · Service lines

What it billed for

CodeServiceShareClaimsBene. recordsPaid
D2392 Resin-based composite - two surfaces, posterior, primary or permanent 16% 13,816 6,735 $1.38M
D2391 Resin-based composite - one surface, posterior, primary or permanent 11% 12,466 6,590 $965K
D2930 Prefabricated stainless steel crown - primary tooth 8.9% 5,441 1,714 $790K
D0145 Oral evaluation for a patient under three years of age 8.4% 5,345 5,314 $748K
D1351 Sealant - per tooth 8.2% 27,433 8,123 $727K
D0120 Dental checkup, returning patientPeriodic oral evaluation - established patient 6.7% 21,225 21,058 $600K
D1120 Dental cleaning, childProphylaxis - child 5.6% 13,869 13,758 $496K
D1110 Prophylaxis - adult 5.0% 8,392 8,332 $449K
D7240 Removal of impacted tooth - completely bony 4.5% 1,477 486 $405K
D1208 Topical application of fluoride, excluding varnish 3.7% 23,185 22,990 $332K
D0230 Intraoral - periapical each additional radiographic image 3.7% 31,005 22,303 $327K
D9230 Inhalation of nitrous oxide / analgesia, anxiolysis 3.6% 12,168 11,817 $319K
24 more codes
D0274 Bitewings - four radiographic images 3.2% 8,939 $287K
D0220 Intraoral - periapical first radiographic image 3.0% 23,653 $270K
D0272 Bitewings - two radiographic images 2.6% 10,201 $227K
D9248 2.0% 1,555 $181K
D2393 Resin-based composite - three surfaces, posterior, primary or permanent <1% 595 $62K
D0150 Comprehensive oral evaluation - new or established patient <1% 1,792 $60K
D0210 Intraoral - complete series of radiographic images <1% 850 $51K
D2934 <1% 319 $45K
D3220 Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction <1% 505 $41K
D0330 Panoramic radiographic image <1% 1,537 $36K
D0160 <1% 2,146 $31K
D2330 <1% 358 $26K
D0140 Limited oral evaluation - problem focused <1% 1,200 $20K
D7111 <1% 1,098 $12K
D9223 Deep sedation/general anesthesia - each subsequent 15 minute increment <1% 103 $6K
D2331 <1% 43 $4K
D9222 <1% 58 $4K
D1330 <1% 259 $3K
D7140 Extraction, erupted tooth or exposed root <1% 29 $2K
D9612 <1% 31 $893.00
D0350 <1% 62 $848.72
D0273 <1% 15 $319.11
D0270 <1% 31 $151.20
D0603 <1% 29,624 $0.02

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.

From NPPES

Who's on the registration

Authorized officialKOUYOUMDJIAN, RAFFY (OWNER)
Same official

Other billing entities under KOUYOUMDJIAN, RAFFY

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Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.