Clinic
Teeth 'R' US Children's Dentistry
Teeth 'R' US Children's Dentistry was paid $1.15M by Medicaid between Jan 2018 and Sep 2024, across 19 billing codes. Its largest line is D0120, dental checkup, returning patient — 25% of everything it billed.
33Billing provider infoTEETH 'R' US CHILDREN'S DENTISTRY
DIAMOND BAR, CA 91765
DIAMOND BAR, CA 91765
33aNPI1063803054assigned 02/11/2015
33bProvider typeDental Clinic/Center
28Total paid$1.15M
24GClaims59,044
24DCodes billed19
24AFirst – last monthJan 2018 – Sep 2024
Compared with peers
Next to other Dental Clinic/Center providers in California
Rank by total paid#224 of 1,135
Median peer was paid$200K
This provider vs. median5.7×
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.
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 | 5,332 | $93K | |
| 2019 | 7,205 | $117K | |
| 2020 | 7,012 | $113K | |
| 2021 | 10,605 | $178K | |
| 2022 | 10,758 | $232K | |
| 2023 | 11,550 | $268K | |
| 2024incomplete | 6,582 | $144K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 25% | 4,928 | 4,902 | $285K |
| D1120 | Dental cleaning, childProphylaxis - child | 21% | 6,265 | 6,234 | $242K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 14% | 2,400 | 1,291 | $160K |
| D0230 | Intraoral - periapical each additional radiographic image | 11% | 28,722 | 5,918 | $128K |
| D1208 | Topical application of fluoride, excluding varnish | 7.1% | 6,389 | 6,357 | $82K |
| D0272 | Bitewings - two radiographic images | 5.3% | 5,349 | 5,322 | $61K |
| D0150 | Comprehensive oral evaluation - new or established patient | 5.0% | 864 | 863 | $58K |
| D1352 | 4.1% | 1,406 | 444 | $47K | |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 1.8% | 259 | 178 | $21K |
| D9430 | 1.2% | 439 | 418 | $14K | |
| D0220 | Intraoral - periapical first radiographic image | <1% | 987 | 958 | $11K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | <1% | 267 | 247 | $11K |
7 more codes
| D1351 | Sealant - per tooth | <1% | 483 | $10K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | <1% | 166 | $9K |
| D7140 | Extraction, erupted tooth or exposed root | <1% | 47 | $3K |
| D2930 | Prefabricated stainless steel crown - primary tooth | <1% | 18 | $2K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | <1% | 19 | $2K |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 14 | $826.00 |
| D1999 | 0% | 22 | $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.
From NPPES
Who's on the registration
Authorized officialONGKORAHARDJO, ANDRIANI (OWNER)