1093140493

1093140493 was paid $125K by Medicaid between Jan 2018 and Dec 2019, across 12 billing codes. Its largest line is D7140, Extraction, erupted tooth or exposed root — 52% of everything it billed.

33Billing provider info1093140493

33aNPI1093140493

33bProvider type—

28Total paid$125K

24GClaims3,668

24DCodes billed12

24AFirst – last monthJan 2018 – Dec 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	1,190	$48K
2019	2,478	$77K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D7140	Extraction, erupted tooth or exposed root	52%	813	321	$65K
D1110	Prophylaxis - adult	14%	451	447	$18K
D0330	Panoramic radiographic image	7.5%	281	267	$9K
D0140	Limited oral evaluation - problem focused	7.0%	336	321	$9K
D0150	Comprehensive oral evaluation - new or established patient	6.3%	278	275	$8K
D0274	Bitewings - four radiographic images	5.1%	315	296	$6K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	2.9%	176	175	$4K
D0220	Intraoral - periapical first radiographic image	2.5%	333	321	$3K
D1206	Topical application of fluoride varnish	2.0%	393	390	$3K
D9311		<1%	15	15	$420.00
D1120	Dental cleaning, childProphylaxis - child	<1%	13	13	$381.60
D1330		0%	264	260	$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.