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NPI 1093886368
NPI deactivated
1093886368
1093886368 was paid $3.33M by Medicaid between Jan 2018 and Jul 2023, across 28 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 31% of everything it billed.
33Billing provider info1093886368
33aNPI1093886368
33bProvider type—
28Total paid$3.33M
24GClaims52,313
24DCodes billed28
24AFirst – last monthJan 2018 – Jul 2023
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 | 11,282 | $534K | |
| 2019 | 8,691 | $448K | |
| 2020 | 6,627 | $303K | |
| 2021 | 7,406 | $419K | |
| 2022 | 13,558 | $1.14M | |
| 2023 | 4,749 | $485K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 31% | 5,243 | 2,180 | $1.03M |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 11% | 3,468 | 2,017 | $370K |
| D7140 | Extraction, erupted tooth or exposed root | 11% | 4,007 | 2,246 | $358K |
| D0150 | Comprehensive oral evaluation - new or established patient | 5.7% | 4,416 | 3,784 | $190K |
| D0272 | Bitewings - two radiographic images | 5.4% | 7,086 | 5,266 | $179K |
| D1120 | Dental cleaning, childProphylaxis - child | 4.5% | 3,500 | 3,219 | $151K |
| D0330 | Panoramic radiographic image | 4.4% | 1,801 | 1,428 | $147K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 4.2% | 1,681 | 1,448 | $141K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 4.2% | 4,318 | 3,286 | $140K |
| D0240 | 3.5% | 4,997 | 2,402 | $116K | |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 3.3% | 1,384 | 1,008 | $110K |
| D0470 | 3.1% | 1,471 | 1,186 | $103K |
16 more codes
| D1206 | Topical application of fluoride varnish | 2.9% | 3,706 | $96K |
| D1510 | 1.6% | 259 | $54K | |
| D0210 | Intraoral - complete series of radiographic images | 1.4% | 440 | $47K |
| D0140 | Limited oral evaluation - problem focused | <1% | 650 | $23K |
| D0220 | Intraoral - periapical first radiographic image | <1% | 1,022 | $15K |
| D1354 | <1% | 935 | $13K | |
| D1208 | Topical application of fluoride, excluding varnish | <1% | 511 | $12K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | <1% | 93 | $10K |
| D1110 | Prophylaxis - adult | <1% | 173 | $6K |
| D1515 | <1% | 18 | $4K | |
| D0274 | Bitewings - four radiographic images | <1% | 138 | $3K |
| D2330 | <1% | 17 | $2K | |
| D1351 | Sealant - per tooth | <1% | 75 | $2K |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 146 | $1K |
| D9420 | <1% | 12 | $1K | |
| D9910 | <1% | 746 | $398.05 |
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.