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NPI 1154743110
NPI deactivated
1154743110
1154743110 was paid $6.72M by Medicaid between Jan 2018 and Dec 2021, across 32 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 15% of everything it billed.
33Billing provider info1154743110
33aNPI1154743110
33bProvider type—
28Total paid$6.72M
24GClaims197,328
24DCodes billed32
24AFirst – last monthJan 2018 – Dec 2021
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 | 44,126 | $1.51M | |
| 2019 | 50,663 | $1.82M | |
| 2020 | 51,187 | $1.61M | |
| 2021 | 51,352 | $1.78M |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 15% | 9,797 | 2,994 | $985K |
| D1120 | Dental cleaning, childProphylaxis - child | 12% | 24,709 | 23,838 | $793K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 8.4% | 24,596 | 23,718 | $561K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 6.6% | 6,447 | 3,768 | $442K |
| D8670 | Periodic orthodontic treatment visit | 6.5% | 4,882 | 4,593 | $434K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 6.0% | 7,175 | 4,086 | $406K |
| D7140 | Extraction, erupted tooth or exposed root | 5.7% | 6,834 | 3,054 | $386K |
| D1208 | Topical application of fluoride, excluding varnish | 5.6% | 19,697 | 18,936 | $378K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 4.0% | 3,587 | 1,520 | $266K |
| D9248 | 3.9% | 3,298 | 2,946 | $260K | |
| D0272 | Bitewings - two radiographic images | 3.0% | 12,140 | 11,696 | $202K |
| D1110 | Prophylaxis - adult | 2.7% | 4,516 | 4,364 | $184K |
20 more codes
| D0210 | Intraoral - complete series of radiographic images | 2.7% | 3,188 | $181K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 2.7% | 6,494 | $179K |
| D1206 | Topical application of fluoride varnish | 2.3% | 8,454 | $158K |
| D0220 | Intraoral - periapical first radiographic image | 2.3% | 13,209 | $156K |
| D0150 | Comprehensive oral evaluation - new or established patient | 2.0% | 4,822 | $134K |
| D0230 | Intraoral - periapical each additional radiographic image | 1.9% | 14,250 | $126K |
| D1351 | Sealant - per tooth | 1.8% | 4,458 | $118K |
| D2934 | 1.4% | 929 | $93K | |
| D0274 | Bitewings - four radiographic images | <1% | 2,165 | $56K |
| D0330 | Panoramic radiographic image | <1% | 1,427 | $48K |
| D0140 | Limited oral evaluation - problem focused | <1% | 2,169 | $47K |
| D8660 | <1% | 962 | $45K | |
| D3230 | <1% | 743 | $36K | |
| D8080 | Comprehensive orthodontic treatment of the adolescent dentition | <1% | 17 | $22K |
| D2332 | <1% | 168 | $12K | |
| D1510 | <1% | 55 | $8K | |
| D2330 | <1% | 97 | $5K | |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | <1% | 20 | $983.95 |
| D9420 | <1% | 1,009 | $530.00 | |
| D1999 | 0% | 5,014 | $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.