TLC Pediatrics Medical Group
TLC Pediatrics Medical Group was paid $423K by Medicaid between Jan 2018 and Sep 2022, across 26 billing codes. Its largest line is 96156, — 29% of everything it billed.
33Billing provider infoTLC PEDIATRICS MEDICAL GROUP
SAN JUAN CAPISTRANO, CA 92675
SAN JUAN CAPISTRANO, CA 92675
33aNPI1356303168assigned 04/05/2006
33bProvider typeSpecialist
28Total paid$423K
24GClaims13,750
24DCodes billed26
24AFirst – last monthJan 2018 – Sep 2022
Compared with peers
Next to other Specialist providers in California
Rank by total paid#306 of 1,230
Median peer was paid$51K
This provider vs. median8.2×
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 | |
|---|---|---|---|
| 2018 | 2,850 | $75K | |
| 2019 | 2,850 | $73K | |
| 2020 | 2,953 | $99K | |
| 2021 | 3,224 | $112K | |
| 2022 | 1,873 | $64K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 96156 | 29% | 1,465 | 1,450 | $125K | |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 22% | 3,643 | 3,229 | $95K |
| 99214 | Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 15% | 1,610 | 1,464 | $65K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | 9.7% | 579 | 576 | $41K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 6.1% | 455 | 454 | $26K |
| 96150 | 3.5% | 640 | 632 | $15K | |
| 92551 | 3.5% | 1,119 | 1,114 | $15K | |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 3.4% | 298 | 298 | $14K |
| 90686 | 1.5% | 724 | 724 | $7K | |
| G0447 | Face-to-face behavioral counseling for obesity, 15 minutes | 1.1% | 213 | 213 | $5K |
| 99395 | Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years | <1% | 25 | 25 | $3K |
| 96127 | <1% | 655 | 646 | $3K |
14 more codes
| 81002 | <1% | 1,292 | $3K | |
| 96151 | <1% | 72 | $2K | |
| 90734 | <1% | 105 | $945.00 | |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | <1% | 13 | $920.66 |
| 85018 | <1% | 337 | $730.42 | |
| 81000 | <1% | 227 | $617.61 | |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | <1% | 13 | $581.75 |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 76 | $531.24 |
| 90670 | <1% | 51 | $459.00 | |
| G8510 | Screening for depression is documented as negative, a follow-up plan is not required | <1% | 42 | $449.40 |
| 90651 | <1% | 38 | $342.00 | |
| 90685 | <1% | 32 | $288.00 | |
| 90633 | <1% | 13 | $117.00 | |
| 99000 | <1% | 13 | $47.19 |
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 officialDAGOSTINO, JOSIANE (MEDICAL MANAGER)