1063638393

1063638393 was paid $971K by Medicaid between Jan 2018 and Dec 2018, across 8 billing codes. Its largest line is D7210, Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth — 37% of everything it billed.

33Billing provider info1063638393

33aNPI1063638393

33bProvider type—

28Total paid$971K

24GClaims9,151

24DCodes billed8

24AFirst – last monthJan 2018 – Dec 2018

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	9,151	$971K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth	37%	3,031	911	$356K
D7240	Removal of impacted tooth - completely bony	21%	902	401	$206K
D9220		15%	771	768	$143K
D7230		7.9%	408	257	$77K
D0150	Comprehensive oral evaluation - new or established patient	7.6%	1,520	1,517	$74K
D9221		5.9%	757	731	$57K
D0330	Panoramic radiographic image	4.0%	1,447	1,445	$39K
D7140	Extraction, erupted tooth or exposed root	1.9%	315	99	$18K

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.