1407845753

1407845753 was paid $640K by Medicaid between Jan 2018 and Mar 2019, across 27 billing codes. Its largest line is D1110, Prophylaxis - adult — 11% of everything it billed.

33Billing provider info1407845753

33aNPI1407845753

33bProvider type—

28Total paid$640K

24GClaims19,271

24DCodes billed27

24AFirst – last monthJan 2018 – Mar 2019

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	16,388	$546K
2019	2,883	$94K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1110	Prophylaxis - adult	11%	2,261	2,255	$73K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	11%	976	804	$70K
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	7.9%	647	550	$51K
D2335		7.5%	418	362	$48K
D2391	Resin-based composite - one surface, posterior, primary or permanent	6.5%	734	638	$42K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	5.1%	2,068	2,063	$33K
D2954		4.2%	203	194	$27K
D2160		4.2%	311	271	$27K
D0210	Intraoral - complete series of radiographic images	4.1%	938	934	$26K
D0230	Intraoral - periapical each additional radiographic image	4.0%	2,015	2,009	$26K
D0150	Comprehensive oral evaluation - new or established patient	3.8%	1,188	1,186	$24K
D2150	Silver amalgam - two surfaces, primary or permanent	3.7%	310	273	$23K

15 more codes

D2791		3.6%	55	$23K
D1351	Sealant - per tooth	3.6%	413	$23K
D0274	Bitewings - four radiographic images	3.1%	1,228	$20K
D0220	Intraoral - periapical first radiographic image	3.0%	2,605	$19K
D1120	Dental cleaning, child	2.9%	639	$19K
D7140	Extraction, erupted tooth or exposed root	1.9%	230	$12K
D4341		1.6%	148	$10K
D2330		1.5%	199	$10K
D1208	Topical application of fluoride, excluding varnish	1.4%	814	$9K
D0272	Bitewings - two radiographic images	1.1%	712	$7K
D2751	Crown - porcelain fused to predominantly base metal	<1%	12	$6K
D2140		<1%	104	$5K
D3320		<1%	16	$5K
D2332		<1%	13	$1K
D2161		<1%	14	$1K

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.