1154403988

1154403988 was paid $281K by Medicaid between Jan 2018 and Mar 2022, across 19 billing codes. Its largest line is D0210, Intraoral - complete series of radiographic images — 17% of everything it billed.

33Billing provider info1154403988

33aNPI1154403988

33bProvider type—

28Total paid$281K

24GClaims9,043

24DCodes billed19

24AFirst – last monthJan 2018 – Mar 2022

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	2,263	$66K
2019	1,576	$49K
2020	2,004	$59K
2021	2,795	$93K
2022	405	$14K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D0210	Intraoral - complete series of radiographic images	17%	928	856	$47K
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth	16%	715	328	$46K
D1110	Prophylaxis - adult	15%	1,262	1,159	$42K
D0150	Comprehensive oral evaluation - new or established patient	13%	1,636	1,518	$36K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	8.1%	448	291	$23K
D7140	Extraction, erupted tooth or exposed root	5.1%	413	197	$14K
D0140	Limited oral evaluation - problem focused	4.8%	577	524	$13K
D2332		3.9%	175	108	$11K
D1120	Dental cleaning, childProphylaxis - child	3.3%	245	235	$9K
D0220	Intraoral - periapical first radiographic image	3.1%	1,275	1,153	$9K
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	2.4%	122	96	$7K
D2391	Resin-based composite - one surface, posterior, primary or permanent	2.1%	159	112	$6K

7 more codes

D0274	Bitewings - four radiographic images	2.1%	253	$6K
D2394		1.2%	65	$3K
D2335		1.1%	41	$3K
D0230	Intraoral - periapical each additional radiographic image	1.0%	566	$3K
D0120	Dental checkup, returning patient	<1%	123	$2K
D9110		<1%	13	$222.69
D9986		<1%	27	$9.00

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.