Su, Jack

Su, Jack was paid $467K by Medicaid between Jan 2018 and Dec 2023, across 15 billing codes. Its largest line is D1110, Prophylaxis - adult — 31% of everything it billed.

33Billing provider infoSU, JACK
BUFFALO, NY 14223

33aNPI1326134941assigned 10/04/2006

33bProvider typeGeneral Practice Dentistry

28Total paid$467K

24GClaims9,926

24DCodes billed15

24AFirst – last monthJan 2018 – Dec 2023

Compared with peers

Next to other General Practice Dentistry providers in New York

Rank by total paid#324 of 2,184

Median peer was paid$54K

This provider vs. median8.7×

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	1,011	$46K
2019	1,185	$52K
2020	1,601	$77K
2021	2,174	$102K
2022	2,020	$97K
2023	1,935	$93K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1110	Prophylaxis - adult	31%	2,714	2,710	$145K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	21%	1,223	872	$99K
D2391	Resin-based composite - one surface, posterior, primary or permanent	16%	1,310	820	$75K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	16%	2,681	2,676	$74K
D0210	Intraoral - complete series of radiographic images	5.9%	507	507	$27K
D0274	Bitewings - four radiographic images	5.8%	982	981	$27K
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	1.7%	81	64	$8K
D0150	Comprehensive oral evaluation - new or established patient	<1%	142	142	$4K
D2330		<1%	45	28	$3K
D1208	Topical application of fluoride, excluding varnish	<1%	151	151	$2K
D7140	Extraction, erupted tooth or exposed root	<1%	21	16	$1K
D1120	Dental cleaning, childProphylaxis - child	<1%	13	12	$500.95

3 more codes

D0140	Limited oral evaluation - problem focused	<1%	17	$233.10
D0220	Intraoral - periapical first radiographic image	<1%	12	$149.82
D1999		0%	27	$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.