1134469372

1134469372 was paid $757K by Medicaid between Dec 2019 and Nov 2023, across 28 billing codes. Its largest line is D0120, dental checkup, returning patient — 34% of everything it billed.

33Billing provider info1134469372

33aNPI1134469372

33bProvider type—

28Total paid$757K

24GClaims52,483

24DCodes billed28

24AFirst – last monthDec 2019 – Nov 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
2019	93	$1K
2020	6,713	$91K
2021	1,642	$22K
2022	23,569	$347K
2023	20,466	$296K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	34%	5,764	5,656	$260K
D1110	Prophylaxis - adult	17%	2,270	2,235	$127K
D1120	Dental cleaning, childProphylaxis - child	10%	4,965	4,862	$77K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	9.5%	1,097	758	$72K
D0150	Comprehensive oral evaluation - new or established patient	7.9%	1,462	1,438	$60K
D0330	Panoramic radiographic image	6.0%	574	562	$46K
D9920		3.3%	418	361	$25K
D1999		3.3%	319	310	$25K
D2391	Resin-based composite - one surface, posterior, primary or permanent	3.1%	522	406	$23K
D1351	Sealant - per tooth	1.7%	1,823	518	$13K
D0210	Intraoral - complete series of radiographic images	<1%	59	59	$7K
D0350		<1%	1,204	1,128	$6K

16 more codes

D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	<1%	222	$4K
D9999	Unspecified adjunctive procedure, by report	<1%	102	$2K
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	<1%	20	$2K
D0230	Intraoral - periapical each additional radiographic image	<1%	5,564	$2K
D0140	Limited oral evaluation - problem focused	<1%	132	$2K
D0274	Bitewings - four radiographic images	<1%	2,151	$1K
D0220	Intraoral - periapical first radiographic image	<1%	4,303	$932.17
D0272	Bitewings - two radiographic images	<1%	3,888	$778.34
D7140	Extraction, erupted tooth or exposed root	<1%	17	$559.34
D1208	Topical application of fluoride, excluding varnish	<1%	6,762	$454.33
D1330		<1%	7,278	$166.95
D3120		<1%	90	$46.00
D1206	Topical application of fluoride varnish	<1%	323	$26.42
D1310		0%	494	$0.00
D9987		0%	130	$0.00
D9986		0%	530	$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.