LEE & WIDODO DDS INC
NPI: 1184972135
· CHINO, CA 91710
· Dental Clinic/Center
· NPI assigned 08/23/2012
$234K
Total Medicaid Paid
Provider Details
| Authorized Official | WIDODO, ANDRE (OWNER) |
| NPI Enumeration Date | 08/23/2012 |
Related Entities
Other providers sharing the same authorized official: WIDODO, ANDRE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
5,067 |
$57K |
| 2019 |
4,290 |
$50K |
| 2020 |
2,462 |
$27K |
| 2021 |
2,849 |
$27K |
| 2022 |
2,291 |
$32K |
| 2023 |
1,751 |
$18K |
| 2024 |
2,090 |
$23K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
13,613 |
2,582 |
$56K |
| D1120 |
Prophylaxis - child |
1,174 |
1,169 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
884 |
879 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,251 |
2,231 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,125 |
2,112 |
$25K |
| D1110 |
Prophylaxis - adult |
243 |
237 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
288 |
285 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
194 |
108 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
12 |
$490.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$156.00 |