Boulos, Samy

Boulos, Samy was paid $49K by Medicaid between Jan 2018 and Jun 2023, across 12 billing codes. Its largest line is D1110, Prophylaxis - adult — 35% of everything it billed.

33Billing provider infoBOULOS, SAMY
SHOREVIEW, MN 55126

33aNPI1275775348assigned 04/03/2009

33bProvider typeGeneral Practice Dentistry

28Total paid$49K

24GClaims3,751

24DCodes billed12

24AFirst – last monthJan 2018 – Jun 2023

Compared with peers

Next to other General Practice Dentistry providers in Minnesota

Rank by total paid#143 of 368

Median peer was paid$19K

This provider vs. median2.5×

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	2,539	$5K
2019	942	$35K
2020	98	$4K
2021	60	$1K
2022	59	$2K
2023	53	$2K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1110	Prophylaxis - adult	35%	746	728	$17K
D0274	Bitewings - four radiographic images	21%	635	621	$10K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	17%	510	496	$8K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	13%	426	244	$6K
D1206	Topical application of fluoride varnish	6.7%	389	376	$3K
D0150	Comprehensive oral evaluation - new or established patient	3.7%	269	268	$2K
D0140	Limited oral evaluation - problem focused	2.7%	175	170	$1K
D0220	Intraoral - periapical first radiographic image	<1%	198	191	$482.56
D1120	Dental cleaning, childProphylaxis - child	<1%	57	57	$421.07
D0330	Panoramic radiographic image	<1%	44	43	$63.07
D2391	Resin-based composite - one surface, posterior, primary or permanent	0%	213	118	$0.00
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	0%	89	67	$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.