ANDRE WIDODO DDS A PROFESSIONAL CORPORATION
NPI: 1447583661
· EL MONTE, CA 91732
· Dental Clinic/Center
· NPI assigned 09/08/2009
$157K
Total Medicaid Paid
Provider Details
| Authorized Official | WIDODO, ANDRE (DENTIST / OWNER) |
| NPI Enumeration Date | 09/08/2009 |
Related Entities
Other providers sharing the same authorized official: WIDODO, ANDRE
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total 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 |
| 2024 |
1,880 |
$28K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
8,619 |
1,894 |
$35K |
| D1110 |
Prophylaxis - adult |
429 |
429 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
643 |
639 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,033 |
1,026 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,112 |
1,106 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
181 |
180 |
$11K |
| D4910 |
|
104 |
103 |
$8K |
| D1120 |
Prophylaxis - child |
155 |
149 |
$5K |
| D4341 |
|
46 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
38 |
38 |
$820.80 |
| D0350 |
|
82 |
52 |
$770.10 |
| D9430 |
|
24 |
24 |
$736.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$130.00 |