1104927524

1104927524 was paid $770K by Medicaid between Jan 2018 and Feb 2019, across 12 billing codes. Its largest line is D9223, Deep sedation/general anesthesia - each subsequent 15 minute increment — 21% of everything it billed.

33Billing provider info1104927524

33aNPI1104927524

33bProvider type—

28Total paid$770K

24GClaims8,402

24DCodes billed12

24AFirst – last monthJan 2018 – Feb 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	7,938	$737K
2019	464	$33K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D9223	Deep sedation/general anesthesia - each subsequent 15 minute increment	21%	1,142	959	$163K
D9222		17%	1,137	1,083	$132K
D7240	Removal of impacted tooth - completely bony	14%	587	225	$108K
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth	9.9%	1,338	453	$76K
D7285		9.7%	514	265	$75K
D7140	Extraction, erupted tooth or exposed root	8.8%	1,186	232	$68K
D7230		8.6%	448	208	$66K
D0330	Panoramic radiographic image	4.3%	756	739	$33K
D0150	Comprehensive oral evaluation - new or established patient	3.2%	969	953	$24K
D7310		2.1%	164	77	$16K
D7320		<1%	52	24	$5K
D0140	Limited oral evaluation - problem focused	<1%	109	108	$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.