Gustafson, Mark

Gustafson, Mark was paid $7K by Medicaid between Jan 2018 and Mar 2018, across 5 billing codes. Its largest line is D0330, Panoramic radiographic image — 38% of everything it billed.

33Billing provider infoGUSTAFSON, MARK
WOOSTER, OH 44691

33aNPI1114033214assigned 08/22/2006

33bProvider typeGeneral Practice Dentistry

28Total paid$7K

24GClaims239

24DCodes billed5

24AFirst – last monthJan 2018 – Mar 2018

Compared with peers

Next to other General Practice Dentistry providers in Ohio

Rank by total paid#627 of 870

Median peer was paid$40K

This provider vs. median0.2×

Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.

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	239	$7K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D0330	Panoramic radiographic image	38%	63	61	$3K
D1110	Prophylaxis - adult	27%	57	55	$2K
D0150	Comprehensive oral evaluation - new or established patient	21%	63	61	$1K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	9.7%	43	42	$637.91
D0140	Limited oral evaluation - problem focused	3.8%	13	12	$250.64

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.