Dental
Peoria ST. Dental and Orthodontics PLLC
Peoria ST. Dental and Orthodontics PLLC was paid $949K by Medicaid between Nov 2021 and Dec 2024, across 26 billing codes. Its largest line is D0350, — 23% of everything it billed.
33Billing provider infoPEORIA ST. DENTAL AND ORTHODONTICS PLLC
AURORA, CO 80011
AURORA, CO 80011
33aNPI1417526294assigned 06/24/2021
33bProvider typeGeneral Practice Dentistry
28Total paid$949K
24GClaims17,862
24DCodes billed26
24AFirst – last monthNov 2021 – Dec 2024
Compared with peers
Next to other General Practice Dentistry providers in Colorado
Rank by total paid#87 of 521
Median peer was paid$53K
This provider vs. median18×
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.
Auditor's notes
Automated statistical signals. Not evidence of fraud — how these are computed.
Entity ProliferationAuthorized official KOUYOUMDJIAN, RAFFY controls 19+ related entities in our dataset. Read more
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 | |
|---|---|---|---|
| 2021 | 107 | $3K | |
| 2022 | 2,575 | $116K | |
| 2023 | 7,499 | $351K | |
| 2024incomplete | 7,681 | $479K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0350 | 23% | 2,275 | 1,118 | $218K | |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 19% | 1,336 | 543 | $179K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 8.5% | 769 | 361 | $81K |
| D1120 | Dental cleaning, childProphylaxis - child | 6.7% | 1,493 | 1,489 | $64K |
| D0150 | Comprehensive oral evaluation - new or established patient | 6.6% | 1,482 | 1,476 | $63K |
| D0230 | Intraoral - periapical each additional radiographic image | 4.6% | 1,778 | 1,771 | $44K |
| D1110 | Prophylaxis - adult | 4.0% | 696 | 692 | $38K |
| D0210 | Intraoral - complete series of radiographic images | 3.8% | 683 | 676 | $36K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 3.2% | 1,075 | 1,071 | $30K |
| D0220 | Intraoral - periapical first radiographic image | 2.7% | 2,001 | 1,983 | $26K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 2.6% | 149 | 79 | $24K |
| D4341 | 1.9% | 69 | 27 | $18K |
14 more codes
| D0274 | Bitewings - four radiographic images | 1.9% | 577 | $18K |
| D1208 | Topical application of fluoride, excluding varnish | 1.6% | 1,165 | $16K |
| D1351 | Sealant - per tooth | 1.6% | 296 | $15K |
| D1206 | Topical application of fluoride varnish | 1.5% | 622 | $14K |
| D1354 | 1.4% | 248 | $14K | |
| D8660 | 1.2% | 80 | $12K | |
| D0272 | Bitewings - two radiographic images | 1.1% | 491 | $11K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 1.1% | 79 | $10K |
| D0330 | Panoramic radiographic image | <1% | 136 | $7K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | <1% | 167 | $5K |
| D0140 | Limited oral evaluation - problem focused | <1% | 81 | $3K |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 85 | $3K |
| D0160 | <1% | 17 | $1K | |
| D0340 | <1% | 12 | $713.16 |
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.
From NPPES
Who's on the registration
Authorized officialKOUYOUMDJIAN, RAFFY (OWNER)
| Provider | Location | Paid |
|---|---|---|
| Rodeo Weslaco Dental & Orthodontics | Weslaco, TX | $14.00M |
| Rodeo Dental Pharr PLLC | Pharr, TX | $10.70M |
| Rodeo Dental San Benito, PLLC | San Benito, TX | $10.54M |
| Pasadena Dental & Orthodontics PLLC | South Houston, TX | $8.93M |
| Rodeo Dental Southmost PLLC | Brownsville, TX | $8.91M |
| FM Katy Dental and Orthodontics, PLLC | Fort Worth, TX | $8.87M |
| Real Smiles | Fort Worth, TX | $7.68M |
| Elsa Dental and Orthodontics, PLLC | Fort Worth, TX | $7.40M |
| Rodeo Laredo Dental & Orthodontics, PLLC | Laredo, TX | $6.12M |
| Rodeo Dental Central PLLC | Brownsville, TX | $6.08M |
| Ruben Torres Dental, PLLC | Brownsville, TX | $5.21M |
| Waco Dental and Orthodontics, PLLC | Waco, TX | $2.19M |
| Cypress Point Dental and Orthodontics, PLLC | Houston, TX | $1.48M |
| Kirkwood Dental and Orthodontics, PLLC | Stafford, TX | $1.18M |
| Midland Dental and Orthodontics, PLLC | Midland, TX | $463K |
| Casa Grande Dental and Orthodontics LLC | Casa Grande, AZ | $199K |
| Phoenix Dental and Orthodontics, PLLC | Phoenix, AZ | $86K |
| Tucson Dental and Orthodontics | Tucson, AZ | $45K |
| 290 Crossing Dental and Orthodontics PLLC | Houston, TX | $16K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.