Dental
ST Moises Dental
ST Moises Dental was paid $320K by Medicaid between Jan 2018 and Dec 2024, across 14 billing codes. Its largest line is D0120, dental checkup, returning patient — 30% of everything it billed.
33Billing provider infoST MOISES DENTAL
POMONA, CA 91766
POMONA, CA 91766
33aNPI1285899443assigned 07/26/2008
33bProvider typeGeneral Practice Dentistry
28Total paid$320K
24GClaims17,536
24DCodes billed14
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other General Practice Dentistry providers in California
Rank by total paid#1,081 of 2,668
Median peer was paid$173K
This provider vs. median1.9×
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 | 3,201 | $41K | |
| 2019 | 76 | $709.20 | |
| 2020 | 249 | $5K | |
| 2021 | 3,440 | $57K | |
| 2022 | 3,299 | $67K | |
| 2023 | 3,803 | $81K | |
| 2024incomplete | 3,468 | $68K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 30% | 1,617 | 1,608 | $95K |
| D1120 | Dental cleaning, childProphylaxis - child | 16% | 1,210 | 1,203 | $50K |
| D0230 | Intraoral - periapical each additional radiographic image | 12% | 9,402 | 1,914 | $37K |
| D1110 | Prophylaxis - adult | 9.0% | 346 | 345 | $29K |
| D0274 | Bitewings - four radiographic images | 7.1% | 1,096 | 1,094 | $23K |
| D1208 | Topical application of fluoride, excluding varnish | 7.0% | 1,834 | 1,818 | $22K |
| D0150 | Comprehensive oral evaluation - new or established patient | 5.8% | 319 | 318 | $19K |
| D2751 | Crown - porcelain fused to predominantly base metal | 3.9% | 26 | 16 | $12K |
| D0210 | Intraoral - complete series of radiographic images | 3.5% | 250 | 249 | $11K |
| D9430 | 2.3% | 236 | 236 | $7K | |
| D0220 | Intraoral - periapical first radiographic image | 2.0% | 562 | 557 | $7K |
| D0350 | 1.3% | 582 | 256 | $4K |
2 more codes
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 officialGOMEZ, UBLESTER (PRESIDENT/OWNER)