Clinic
Widodo & Lee DDS a Professional Dental Corp
Widodo & Lee DDS a Professional Dental Corp was paid $609K by Medicaid between Jan 2018 and Dec 2024, across 13 billing codes. Its largest line is D0230, Intraoral - periapical each additional radiographic image — 20% of everything it billed.
33Billing provider infoWIDODO & LEE DDS A PROFESSIONAL DENTAL CORP
POMONA, CA 91766
POMONA, CA 91766
33aNPI1245589282assigned 09/06/2012
33bProvider typeDental Clinic/Center
28Total paid$609K
24GClaims46,115
24DCodes billed13
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Dental Clinic/Center providers in California
Rank by total paid#332 of 1,135
Median peer was paid$200K
This provider vs. median3.0×
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 | 9,224 | $109K | |
| 2019 | 7,779 | $110K | |
| 2020 | 4,701 | $52K | |
| 2021 | 5,452 | $61K | |
| 2022 | 6,795 | $105K | |
| 2023 | 6,115 | $88K | |
| 2024incomplete | 6,049 | $82K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0230 | Intraoral - periapical each additional radiographic image | 20% | 29,185 | 5,403 | $119K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 16% | 2,031 | 2,026 | $100K |
| D1120 | Dental cleaning, childProphylaxis - child | 16% | 2,692 | 2,677 | $100K |
| D1110 | Prophylaxis - adult | 12% | 875 | 868 | $75K |
| D1208 | Topical application of fluoride, excluding varnish | 9.6% | 4,723 | 4,689 | $58K |
| D0272 | Bitewings - two radiographic images | 9.5% | 4,919 | 4,880 | $58K |
| D0150 | Comprehensive oral evaluation - new or established patient | 8.6% | 852 | 836 | $52K |
| D2150 | Silver amalgam - two surfaces, primary or permanent | 4.7% | 430 | 254 | $29K |
| D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | 2.1% | 109 | 78 | $13K |
| D0350 | <1% | 210 | 87 | $2K | |
| D2140 | <1% | 23 | 12 | $1K | |
| D0220 | Intraoral - periapical first radiographic image | <1% | 54 | 54 | $594.00 |
1 more codes
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | <1% | 12 | $480.00 |
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 |
|---|---|---|
| Lee & Widodo DDS INC | Chino, CA | $234K |
| 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.