Clinic
Andre Widodo DDS a Professional Corporation
Andre Widodo DDS a Professional Corporation was paid $157K by Medicaid between Jan 2018 and Nov 2024, across 13 billing codes. Its largest line is D0230, Intraoral - periapical each additional radiographic image — 23% of everything it billed.
33Billing provider infoANDRE WIDODO DDS A PROFESSIONAL CORPORATION
EL MONTE, CA 91732
EL MONTE, CA 91732
33aNPI1447583661assigned 09/08/2009
33bProvider typeDental Clinic/Center
28Total paid$157K
24GClaims12,479
24DCodes billed13
24AFirst – last monthJan 2018 – Nov 2024
Compared with peers
Next to other Dental Clinic/Center providers in California
Rank by total paid#611 of 1,135
Median peer was paid$200K
This provider vs. median0.8×
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 | 2,509 | $30K | |
| 2019 | 2,040 | $26K | |
| 2020 | 1,056 | $11K | |
| 2021 | 1,377 | $12K | |
| 2022 | 1,801 | $23K | |
| 2023 | 1,816 | $27K | |
| 2024incomplete | 1,880 | $28K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0230 | Intraoral - periapical each additional radiographic image | 23% | 8,619 | 1,894 | $35K |
| D1110 | Prophylaxis - adult | 22% | 429 | 429 | $34K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 21% | 643 | 639 | $33K |
| D1208 | Topical application of fluoride, excluding varnish | 8.2% | 1,033 | 1,026 | $13K |
| D0272 | Bitewings - two radiographic images | 8.2% | 1,112 | 1,106 | $13K |
| D0150 | Comprehensive oral evaluation - new or established patient | 6.8% | 181 | 180 | $11K |
| D4910 | 5.1% | 104 | 103 | $8K | |
| D1120 | Dental cleaning, childProphylaxis - child | 3.2% | 155 | 149 | $5K |
| D4341 | 1.5% | 46 | 12 | $2K | |
| D0274 | Bitewings - four radiographic images | <1% | 38 | 38 | $820.80 |
| D0350 | <1% | 82 | 52 | $770.10 | |
| D9430 | <1% | 24 | 24 | $736.00 |
1 more codes
| D0220 | Intraoral - periapical first radiographic image | <1% | 13 | $130.00 |
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.
From NPPES
Who's on the registration
Authorized officialWIDODO, ANDRE (DENTIST / OWNER)
| Provider | Location | Paid |
|---|---|---|
| Widodo & Lee DDS a Professional Dental Corp | Pomona, CA | $609K |
| Lee & Widodo DDS INC | Chino, CA | $234K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.