Dental
Rossarin Mitsumoto D.D.S., P.C.
Rossarin Mitsumoto D.D.S., P.C. was paid $21K by Medicaid between Oct 2019 and Nov 2024, across 7 billing codes. Its largest line is D1120, dental cleaning, child — 31% of everything it billed.
33Billing provider infoROSSARIN MITSUMOTO D.D.S., P.C.
SLEEPY HOLLOW, NY 10591
SLEEPY HOLLOW, NY 10591
33aNPI1316467269assigned 06/21/2017
33bProvider typePediatric Dentist
28Total paid$21K
24GClaims1,046
24DCodes billed7
24AFirst – last monthOct 2019 – Nov 2024
Compared with peers
Next to other Pediatric Dentist providers in New York
Rank by total paid#402 of 514
Median peer was paid$196K
This provider vs. median0.1×
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 | |
|---|---|---|---|
| 2019 | 44 | $1K | |
| 2020 | 66 | $2K | |
| 2021 | 98 | $2K | |
| 2022 | 88 | $2K | |
| 2023 | 364 | $8K | |
| 2024incomplete | 386 | $7K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 31% | 160 | 160 | $7K |
| D1208 | Topical application of fluoride, excluding varnish | 23% | 353 | 353 | $5K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 22% | 193 | 193 | $5K |
| D0274 | Bitewings - four radiographic images | 15% | 133 | 133 | $3K |
| D0220 | Intraoral - periapical first radiographic image | 4.0% | 111 | 111 | $856.00 |
| D1110 | Prophylaxis - adult | 3.0% | 14 | 14 | $630.00 |
| D0230 | Intraoral - periapical each additional radiographic image | 1.9% | 82 | 82 | $415.00 |
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 officialMITSUMOTO, ROSSARIN (OWNER)