Petersen, Luke

Petersen, Luke was paid $78K by Medicaid between Apr 2019 and Feb 2020, across 12 billing codes. Its largest line is D0120, dental checkup, returning patient — 56% of everything it billed.

33Billing provider infoPETERSEN, LUKE
WEST JORDAN, UT 84088

33aNPI1336450816assigned 06/29/2010

33bProvider typeDentist

28Total paid$78K

24GClaims3,085

24DCodes billed12

24AFirst – last monthApr 2019 – Feb 2020

Compared with peers

Next to other Dentist providers in Utah

Rank by total paid#50 of 136

Median peer was paid$35K

This provider vs. median2.2×

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	2,951	$73K
2020	134	$5K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	56%	554	546	$44K
D1120	Dental cleaning, childProphylaxis - child	16%	545	538	$12K
D2150	Silver amalgam - two surfaces, primary or permanent	11%	138	76	$8K
D0150	Comprehensive oral evaluation - new or established patient	7.6%	51	49	$6K
D2140		4.5%	75	54	$4K
D1351	Sealant - per tooth	4.4%	91	19	$3K
D1206	Topical application of fluoride varnish	<1%	613	603	$464.00
D0220	Intraoral - periapical first radiographic image	<1%	351	344	$404.95
D0230	Intraoral - periapical each additional radiographic image	<1%	335	314	$55.53
D0272	Bitewings - two radiographic images	<1%	183	177	$19.90
D0274	Bitewings - four radiographic images	0%	116	112	$0.00
D1110	Prophylaxis - adult	0%	33	33	$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.