1043586720

1043586720 was paid $4.19M by Medicaid between Jan 2018 and Dec 2021, across 28 billing codes. Its largest line is D1120, dental cleaning, child — 14% of everything it billed.

33Billing provider info1043586720

33aNPI1043586720

33bProvider type—

28Total paid$4.19M

24GClaims129,467

24DCodes billed28

24AFirst – last monthJan 2018 – Dec 2021

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	26,449	$965K
2019	31,888	$1.03M
2020	34,638	$977K
2021	36,492	$1.22M

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1120	Dental cleaning, childProphylaxis - child	14%	19,285	17,756	$584K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	12%	8,076	3,458	$515K
D2930	Prefabricated stainless steel crown - primary tooth	10%	4,357	1,546	$423K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	9.4%	18,305	16,815	$396K
D1206	Topical application of fluoride varnish	8.2%	18,341	16,813	$342K
D8670	Periodic orthodontic treatment visit	6.0%	2,955	2,711	$252K
D7140	Extraction, erupted tooth or exposed root	5.4%	4,085	1,960	$225K
D2391	Resin-based composite - one surface, posterior, primary or permanent	4.8%	3,850	2,150	$200K
D0210	Intraoral - complete series of radiographic images	4.2%	3,312	3,069	$176K
D1110	Prophylaxis - adult	3.8%	4,163	3,826	$159K
D9248		3.3%	1,918	1,623	$137K
D0150	Comprehensive oral evaluation - new or established patient	3.2%	4,965	4,606	$132K

16 more codes

D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	3.1%	5,001	$131K
D1351	Sealant - per tooth	3.1%	5,341	$128K
D0272	Bitewings - two radiographic images	2.9%	7,610	$122K
D1208	Topical application of fluoride, excluding varnish	1.9%	4,412	$82K
D0274	Bitewings - four radiographic images	1.1%	2,002	$48K
D0140	Limited oral evaluation - problem focused	<1%	1,804	$39K
D0220	Intraoral - periapical first radiographic image	<1%	3,393	$37K
D3220	Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction	<1%	325	$22K
D8660		<1%	347	$14K
D0330	Panoramic radiographic image	<1%	201	$8K
D0230	Intraoral - periapical each additional radiographic image	<1%	929	$8K
D1515		<1%	34	$3K
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	<1%	45	$3K
D2330		<1%	47	$3K
D2332		<1%	19	$2K
D1999		0%	4,345	$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.