Dental
Agung Pribadi DDS INC
Agung Pribadi DDS INC was paid $69K by Medicaid between Jan 2018 and Sep 2024, across 6 billing codes. Its largest line is D0120, dental checkup, returning patient — 49% of everything it billed.
33Billing provider infoAGUNG PRIBADI DDS INC
LA HABRA, CA 90631
LA HABRA, CA 90631
33aNPI1295830487assigned 09/13/2006
33bProvider typeGeneral Practice Dentistry
28Total paid$69K
24GClaims2,583
24DCodes billed6
24AFirst – last monthJan 2018 – Sep 2024
Compared with peers
Next to other General Practice Dentistry providers in California
Rank by total paid#1,686 of 2,668
Median peer was paid$173K
This provider vs. median0.4×
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 | 274 | $5K | |
| 2019 | 294 | $7K | |
| 2020 | 319 | $7K | |
| 2021 | 467 | $9K | |
| 2022 | 380 | $12K | |
| 2023 | 572 | $19K | |
| 2024incomplete | 277 | $10K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 49% | 558 | 558 | $34K |
| D0230 | Intraoral - periapical each additional radiographic image | 16% | 838 | 811 | $11K |
| D1120 | Dental cleaning, childProphylaxis - child | 15% | 265 | 265 | $10K |
| D1208 | Topical application of fluoride, excluding varnish | 14% | 769 | 769 | $10K |
| D0274 | Bitewings - four radiographic images | 4.4% | 141 | 141 | $3K |
| D0150 | Comprehensive oral evaluation - new or established patient | 1.1% | 12 | 12 | $761.00 |
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 officialPRIBADI, AGUNG (CEO)