Dental
Simon, Thomas
Simon, Thomas was paid $256K by Medicaid between Jan 2018 and Jun 2018, across 20 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 33% of everything it billed.
33Billing provider infoSIMON, THOMAS
GRANT, MI 49327
GRANT, MI 49327
33aNPI1073775516assigned 06/26/2008
33bProvider typeGeneral Practice Dentistry
28Total paid$256K
24GClaims4,006
24DCodes billed20
24AFirst – last monthJan 2018 – Jun 2018
Compared with peers
Next to other General Practice Dentistry providers in Michigan
Rank by total paid#210 of 1,554
Median peer was paid$15K
This provider vs. median18×
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 | 4,006 | $256K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 33% | 430 | 146 | $85K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 11% | 277 | 123 | $27K |
| D1120 | Dental cleaning, childProphylaxis - child | 7.9% | 470 | 469 | $20K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 6.4% | 126 | 83 | $16K |
| D7140 | Extraction, erupted tooth or exposed root | 5.6% | 161 | 89 | $14K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 4.5% | 336 | 335 | $12K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 4.5% | 89 | 56 | $12K |
| D9223 | Deep sedation/general anesthesia - each subsequent 15 minute increment | 4.5% | 109 | 20 | $11K |
| D0230 | Intraoral - periapical each additional radiographic image | 4.3% | 805 | 278 | $11K |
| D1208 | Topical application of fluoride, excluding varnish | 3.3% | 289 | 288 | $9K |
| D2390 | 3.0% | 37 | 14 | $8K | |
| D0220 | Intraoral - periapical first radiographic image | 2.3% | 301 | 301 | $6K |
8 more codes
| D1206 | Topical application of fluoride varnish | 2.0% | 176 | $5K |
| D9248 | 1.7% | 75 | $4K | |
| D0150 | Comprehensive oral evaluation - new or established patient | 1.6% | 66 | $4K |
| D0140 | Limited oral evaluation - problem focused | 1.5% | 62 | $4K |
| D1351 | Sealant - per tooth | 1.1% | 79 | $3K |
| D9222 | <1% | 20 | $2K | |
| D0272 | Bitewings - two radiographic images | <1% | 73 | $2K |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 25 | $1K |
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.