1366578890

1366578890 was paid $69K by Medicaid between Jan 2018 and Aug 2022, across 8 billing codes. Its largest line is D9430, — 41% of everything it billed.

33Billing provider info1366578890

33aNPI1366578890

33bProvider type—

28Total paid$69K

24GClaims2,156

24DCodes billed8

24AFirst – last monthJan 2018 – Aug 2022

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	355	$9K
2019	458	$15K
2020	714	$19K
2021	590	$24K
2022	39	$2K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D9430		41%	899	891	$28K
D1110	Prophylaxis - adult	25%	219	217	$17K
D0150	Comprehensive oral evaluation - new or established patient	14%	161	161	$10K
D0220	Intraoral - periapical first radiographic image	12%	715	684	$8K
D0210	Intraoral - complete series of radiographic images	4.2%	62	62	$3K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	2.6%	28	12	$2K
D2920		<1%	17	12	$672.00
D0230	Intraoral - periapical each additional radiographic image	<1%	55	30	$234.21

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.