1104857648

1104857648 was paid $372K by Medicaid between Jan 2018 and Aug 2020, across 9 billing codes. Its largest line is D8670, Periodic orthodontic treatment visit — 64% of everything it billed.

33Billing provider info1104857648

33aNPI1104857648

33bProvider type—

28Total paid$372K

24GClaims3,323

24DCodes billed9

24AFirst – last monthJan 2018 – Aug 2020

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	1,265	$125K
2019	1,588	$175K
2020	470	$72K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D8670	Periodic orthodontic treatment visit	64%	1,322	1,117	$240K
D8030		12%	530	522	$44K
D8080	Comprehensive orthodontic treatment of the adolescent dentition	9.1%	70	65	$34K
D0340		4.2%	273	270	$15K
D8680		3.3%	63	34	$12K
D0330	Panoramic radiographic image	3.1%	273	270	$11K
D0150	Comprehensive oral evaluation - new or established patient	2.5%	407	395	$9K
D0350		<1%	273	270	$3K
D0470		<1%	112	111	$2K

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.