1356359046

1356359046 was paid $139K by Medicaid between Jun 2018 and Jul 2024, across 11 billing codes. Its largest line is D7240, Removal of impacted tooth - completely bony — 27% of everything it billed.

33Billing provider info1356359046

33aNPI1356359046

33bProvider type—

28Total paid$139K

24GClaims1,077

24DCodes billed11

24AFirst – last monthJun 2018 – Jul 2024

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	279	$9K
2022	67	$5K
2023	244	$24K
2024incomplete	487	$101K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D7240	Removal of impacted tooth - completely bony	27%	100	47	$37K
D9223	Deep sedation/general anesthesia - each subsequent 15 minute increment	25%	123	114	$35K
D9310		16%	327	319	$23K
D7230		12%	59	32	$17K
D9222		10%	127	115	$14K
D1206	Topical application of fluoride varnish	2.5%	99	32	$3K
D0330	Panoramic radiographic image	2.1%	33	33	$3K
D1120	Dental cleaning, childProphylaxis - child	2.1%	69	23	$3K
D0274	Bitewings - four radiographic images	<1%	54	18	$1K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	<1%	57	19	$1K
D0431		<1%	29	29	$986.00

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.