Granados Paucar, Luis

Granados Paucar, Luis was paid $25K by Medicaid between Oct 2019 and Mar 2020, across 15 billing codes. Its largest line is D1120, dental cleaning, child — 28% of everything it billed.

33Billing provider infoGRANADOS PAUCAR, LUIS
GLENDALE HEIGHTS, IL 60139

33aNPI1063948222assigned 05/10/2017

33bProvider typeGeneral Practice Dentistry

28Total paid$25K

24GClaims1,544

24DCodes billed15

24AFirst – last monthOct 2019 – Mar 2020

Compared with peers

Next to other General Practice Dentistry providers in Illinois

Rank by total paid#734 of 1,017

Median peer was paid$123K

This provider vs. median0.2×

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
2019	502	$4K
2020	1,042	$21K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1120	Dental cleaning, childProphylaxis - child	28%	238	210	$7K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	21%	272	233	$5K
D1208	Topical application of fluoride, excluding varnish	9.4%	103	103	$2K
D2391	Resin-based composite - one surface, posterior, primary or permanent	9.1%	51	35	$2K
D1206	Topical application of fluoride varnish	7.1%	123	96	$2K
D0274	Bitewings - four radiographic images	5.2%	123	106	$1K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	4.9%	37	30	$1K
D1351	Sealant - per tooth	4.0%	23	12	$1K
D0220	Intraoral - periapical first radiographic image	3.5%	251	209	$901.60
D0230	Intraoral - periapical each additional radiographic image	2.3%	209	174	$585.20
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth	1.4%	14	13	$353.65
D0272	Bitewings - two radiographic images	1.2%	42	42	$300.80

3 more codes

D9310		1.1%	31	$290.70
D1110	Prophylaxis - adult	1.1%	12	$287.00
D0140	Limited oral evaluation - problem focused	<1%	15	$178.20

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.