Roukema, Peter

Roukema, Peter was paid $5K by Medicaid between Jan 2018 and Jan 2018, across 7 billing codes. Its largest line is D0150, Comprehensive oral evaluation - new or established patient — 30% of everything it billed.

33Billing provider infoROUKEMA, PETER
PAGOSA SPRINGS, CO 81147

33aNPI1457525263assigned 04/14/2008

33bProvider typeDentist

28Total paid$5K

24GClaims166

24DCodes billed7

24AFirst – last monthJan 2018 – Jan 2018

Compared with peers

Next to other Dentist providers in Colorado

Rank by total paid#270 of 344

Median peer was paid$45K

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	166	$5K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D0150	Comprehensive oral evaluation - new or established patient	30%	39	39	$1K
D1110	Prophylaxis - adult	23%	26	26	$1K
D0274	Bitewings - four radiographic images	15%	23	23	$698.28
D0140	Limited oral evaluation - problem focused	11%	16	16	$485.76
D0230	Intraoral - periapical each additional radiographic image	7.8%	18	18	$354.54
D0220	Intraoral - periapical first radiographic image	6.7%	27	27	$303.68
D1208	Topical application of fluoride, excluding varnish	6.6%	17	17	$298.88

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.