1053353342

1053353342 was paid $615K by Medicaid between Jan 2018 and Nov 2024, across 50 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 27% of everything it billed.

33Billing provider info1053353342

33aNPI1053353342

33bProvider type—

28Total paid$615K

24GClaims28,378

24DCodes billed50

24AFirst – last monthJan 2018 – Nov 2024

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	15,691	$419K
2019	4,291	$99K
2020	499	$8K
2021	1,642	$27K
2022	2,591	$27K
2023	2,363	$23K
2024incomplete	1,301	$13K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	27%	5,709	5,000	$167K
T1015	A visit at a community health center or clinic (one all-in rate)Clinic visit/encounter, all-inclusive	18%	773	638	$113K
D1110	Prophylaxis - adult	6.9%	2,894	2,876	$43K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	5.4%	2,427	2,405	$34K
99214	Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	4.8%	906	863	$30K
99212	Office or other outpatient visit for the evaluation and management of an established patient, straightforward	4.2%	1,060	1,000	$26K
D2391	Resin-based composite - one surface, posterior, primary or permanent	4.1%	809	585	$25K
D0150	Comprehensive oral evaluation - new or established patient	4.0%	1,210	1,203	$24K
D0140	Limited oral evaluation - problem focused	2.6%	1,278	1,202	$16K
D1120	Dental cleaning, childProphylaxis - child	2.3%	1,086	1,074	$14K
99393	Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years)	2.2%	301	297	$13K
99392	Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years)	1.8%	268	263	$11K

38 more codes

90460	Immunization administration through 18 years of age via any route, first or only component	1.7%	654	$11K
D1208	Topical application of fluoride, excluding varnish	1.6%	1,031	$10K
59426		1.5%	159	$9K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	1.5%	240	$9K
D0210	Intraoral - complete series of radiographic images	1.4%	409	$8K
99394	Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years)	1.1%	136	$7K
99391	Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year)	1.0%	168	$6K
99396	Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years	<1%	128	$5K
90471	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine	<1%	351	$4K
59425		<1%	88	$4K
96110	Developmental screening, with scoring and documentation, per standardized instrument	<1%	620	$3K
D0274	Bitewings - four radiographic images	<1%	359	$3K
D0220	Intraoral - periapical first radiographic image	<1%	609	$2K
90472	Immunization administration, each additional vaccine (list separately)	<1%	154	$2K
D2335		<1%	33	$2K
99211	Office or other outpatient visit for the evaluation and management of an established patient, minimal severity	<1%	221	$2K
99395	Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years	<1%	44	$2K
90686		<1%	131	$1K
V5008	Hearing screening	<1%	665	$1K
90670		<1%	15	$1K
87880	Infectious agent antigen detection by immunoassay; Streptococcus, group A	<1%	151	$1K
90461		<1%	110	$1K
99173		<1%	667	$807.72
88150		<1%	140	$750.92
59050		<1%	17	$629.89
81025		<1%	142	$491.43
36415	Collection of venous blood by venipuncture	<1%	117	$480.49
D7140	Extraction, erupted tooth or exposed root	<1%	15	$440.00
97802		<1%	162	$260.59
82947		<1%	191	$227.09
92551		<1%	46	$95.00
87804	Infectious agent antigen detection by immunoassay; Influenza, each type	<1%	17	$89.37
81001		<1%	48	$84.66
D0272	Bitewings - two radiographic images	<1%	14	$70.00
81003		<1%	27	$15.39
D1330		0%	1,454	$0.00
99000		0%	109	$0.00
99070		0%	15	$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.