Rostvold, Kimberly

Rostvold, Kimberly was paid $1K by Medicaid between Oct 2018 and Oct 2018, across 4 billing codes. Its largest line is D1120, dental cleaning, child — 36% of everything it billed.

33Billing provider infoROSTVOLD, KIMBERLY
HERMANTOWN, MN 55811

33aNPI1417479700assigned 07/09/2017

33bProvider typeDentist

28Total paid$1K

24GClaims63

24DCodes billed4

24AFirst – last monthOct 2018 – Oct 2018

Compared with peers

Next to other Dentist providers in Minnesota

Rank by total paid#143 of 192

Median peer was paid$9K

This provider vs. median0.1×

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	63	$1K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1120	Dental cleaning, childProphylaxis - child	36%	16	16	$485.00
D1206	Topical application of fluoride varnish	25%	18	18	$340.25
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	24%	16	16	$320.00
D0272	Bitewings - two radiographic images	15%	13	13	$208.00

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.