Clinic
Lee & Widodo DDS INC
Lee & Widodo DDS INC was paid $234K by Medicaid between Jan 2018 and Nov 2024, across 10 billing codes. Its largest line is D0230, Intraoral - periapical each additional radiographic image — 24% of everything it billed.
33Billing provider infoLEE & WIDODO DDS INC
CHINO, CA 91710
CHINO, CA 91710
33aNPI1184972135assigned 08/23/2012
33bProvider typeDental Clinic/Center
28Total paid$234K
24GClaims20,800
24DCodes billed10
24AFirst – last monthJan 2018 – Nov 2024
Compared with peers
Next to other Dental Clinic/Center providers in California
Rank by total paid#545 of 1,135
Median peer was paid$200K
This provider vs. median1.2×
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 | 5,067 | $57K | |
| 2019 | 4,290 | $50K | |
| 2020 | 2,462 | $27K | |
| 2021 | 2,849 | $27K | |
| 2022 | 2,291 | $32K | |
| 2023 | 1,751 | $18K | |
| 2024incomplete | 2,090 | $23K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0230 | Intraoral - periapical each additional radiographic image | 24% | 13,613 | 2,582 | $56K |
| D1120 | Dental cleaning, childProphylaxis - child | 17% | 1,174 | 1,169 | $39K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 16% | 884 | 879 | $38K |
| D0272 | Bitewings - two radiographic images | 11% | 2,251 | 2,231 | $26K |
| D1208 | Topical application of fluoride, excluding varnish | 11% | 2,125 | 2,112 | $25K |
| D1110 | Prophylaxis - adult | 7.8% | 243 | 237 | $18K |
| D0150 | Comprehensive oral evaluation - new or established patient | 7.3% | 288 | 285 | $17K |
| D2150 | Silver amalgam - two surfaces, primary or permanent | 5.5% | 194 | 108 | $13K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | <1% | 15 | 12 | $490.00 |
| D0220 | Intraoral - periapical first radiographic image | <1% | 13 | 13 | $156.00 |
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.
From NPPES
Who's on the registration
Authorized officialWIDODO, ANDRE (OWNER)
| Provider | Location | Paid |
|---|---|---|
| Widodo & Lee DDS a Professional Dental Corp | Pomona, CA | $609K |
| Andre Widodo DDS a Professional Corporation | El Monte, CA | $157K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.