Clinic
Great Wall Clinic
Great Wall Clinic was paid $21K by Medicaid between Jan 2018 and Jul 2019, across 12 billing codes. Its largest line is D1110, Prophylaxis - adult — 23% of everything it billed.
33Billing provider infoGREAT WALL CLINIC
KENT, WA 98032
KENT, WA 98032
33aNPI1184952079assigned 12/03/2009
33bProvider typeDental Clinic/Center
28Total paid$21K
24GClaims1,084
24DCodes billed12
24AFirst – last monthJan 2018 – Jul 2019
Compared with peers
Next to other Dental Clinic/Center providers in Washington
Rank by total paid#118 of 143
Median peer was paid$573K
This provider vs. median0.0×
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 | 772 | $16K | |
| 2019 | 312 | $5K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 23% | 156 | 153 | $5K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 14% | 148 | 147 | $3K |
| D0140 | Limited oral evaluation - problem focused | 14% | 168 | 144 | $3K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 11% | 51 | 30 | $2K |
| D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | 10% | 38 | 14 | $2K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 6.3% | 36 | 12 | $1K |
| D9110 | 5.6% | 28 | 26 | $1K | |
| D0220 | Intraoral - periapical first radiographic image | 5.4% | 180 | 165 | $1K |
| D0274 | Bitewings - four radiographic images | 4.4% | 102 | 100 | $930.51 |
| D0150 | Comprehensive oral evaluation - new or established patient | 3.7% | 32 | 31 | $789.20 |
| D1208 | Topical application of fluoride, excluding varnish | 1.7% | 28 | 28 | $368.21 |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 117 | 49 | $168.21 |
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.
From NPPES
Who's on the registration
Authorized officialROLLOLAZO, EPHRAIM (OFFICE MANAGER)