1073787594

1073787594 was paid $271K by Medicaid between Feb 2018 and Jun 2019, across 21 billing codes. Its largest line is D1120, dental cleaning, child — 15% of everything it billed.

33Billing provider info1073787594

33aNPI1073787594

33bProvider type—

28Total paid$271K

24GClaims12,885

24DCodes billed21

24AFirst – last monthFeb 2018 – Jun 2019

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	4,245	$17K
2019	8,640	$255K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1120	Dental cleaning, childProphylaxis - child	15%	1,037	898	$42K
D1206	Topical application of fluoride varnish	14%	1,034	888	$38K
D4341		11%	481	97	$29K
D2150	Silver amalgam - two surfaces, primary or permanent	9.8%	516	289	$27K
D0140	Limited oral evaluation - problem focused	8.8%	992	849	$24K
D0274	Bitewings - four radiographic images	5.7%	971	822	$16K
D3110		4.7%	858	396	$13K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	4.5%	1,092	752	$12K
D2140		4.4%	264	185	$12K
D1351	Sealant - per tooth	4.3%	807	223	$12K
D0230	Intraoral - periapical each additional radiographic image	3.5%	2,104	1,007	$10K
D2160		2.7%	122	75	$7K

9 more codes

D2930	Prefabricated stainless steel crown - primary tooth	2.5%	132	$7K
D7140	Extraction, erupted tooth or exposed root	2.1%	193	$6K
D9215		1.9%	1,416	$5K
D0220	Intraoral - periapical first radiographic image	1.7%	462	$5K
D0330	Panoramic radiographic image	1.6%	170	$4K
D3220	Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction	1.2%	107	$3K
D0150	Comprehensive oral evaluation - new or established patient	<1%	63	$1K
D1208	Topical application of fluoride, excluding varnish	<1%	33	$122.88
D0120	Dental checkup, returning patient	0%	31	$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.