Dental
Susanto, Melisa
Susanto, Melisa was paid $1.23M by Medicaid between Jan 2018 and Dec 2024, across 20 billing codes. Its largest line is D0120, dental checkup, returning patient — 17% of everything it billed.
33Billing provider infoSUSANTO, MELISA
PUYALLUP, WA 98375
PUYALLUP, WA 98375
33aNPI1396044517assigned 03/28/2011
33bProvider typeGeneral Practice Dentistry
28Total paid$1.23M
24GClaims61,610
24DCodes billed20
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other General Practice Dentistry providers in Washington
Rank by total paid#43 of 319
Median peer was paid$22K
This provider vs. median57×
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 | 4,168 | $73K | |
| 2019 | 8,406 | $174K | |
| 2020 | 7,692 | $144K | |
| 2021 | 8,404 | $154K | |
| 2022 | 9,883 | $166K | |
| 2023 | 11,421 | $253K | |
| 2024incomplete | 11,636 | $262K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 17% | 7,170 | 7,150 | $214K |
| D1206 | Topical application of fluoride varnish | 16% | 8,973 | 8,862 | $197K |
| D1120 | Dental cleaning, childProphylaxis - child | 15% | 7,743 | 7,673 | $184K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 13% | 1,223 | 288 | $164K |
| D9999 | Unspecified adjunctive procedure, by report | 11% | 4,550 | 4,485 | $138K |
| D0150 | Comprehensive oral evaluation - new or established patient | 6.4% | 1,962 | 1,888 | $79K |
| D0220 | Intraoral - periapical first radiographic image | 3.3% | 4,994 | 4,856 | $40K |
| D0230 | Intraoral - periapical each additional radiographic image | 2.6% | 14,154 | 4,126 | $32K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 2.6% | 1,421 | 1,360 | $32K |
| D1351 | Sealant - per tooth | 2.4% | 1,453 | 539 | $30K |
| D9920 | 1.6% | 651 | 643 | $20K | |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 1.5% | 244 | 165 | $18K |
8 more codes
| D0272 | Bitewings - two radiographic images | 1.1% | 1,361 | $14K |
| D0140 | Limited oral evaluation - problem focused | 1.1% | 639 | $13K |
| D7140 | Extraction, erupted tooth or exposed root | 1.0% | 187 | $12K |
| D1999 | 1.0% | 1,009 | $12K | |
| D1354 | <1% | 3,376 | $11K | |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | <1% | 150 | $9K |
| D0330 | Panoramic radiographic image | <1% | 159 | $6K |
| D3120 | 0% | 191 | $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.