Dental
Ethan C.A. Lee Dental INC.
Ethan C.A. Lee Dental INC. was paid $23K by Medicaid between Mar 2019 and Aug 2024, across 9 billing codes. Its largest line is D1110, Prophylaxis - adult — 25% of everything it billed.
33Billing provider infoETHAN C.A. LEE DENTAL INC.
SAN GABRIEL, CA 91776
SAN GABRIEL, CA 91776
33aNPI1477044345assigned 05/25/2018
33bProvider typeGeneral Practice Dentistry
28Total paid$23K
24GClaims458
24DCodes billed9
24AFirst – last monthMar 2019 – Aug 2024
Compared with peers
Next to other General Practice Dentistry providers in California
Rank by total paid#2,001 of 2,668
Median peer was paid$173K
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 | |
|---|---|---|---|
| 2019 | 177 | $10K | |
| 2020 | 31 | $2K | |
| 2021 | 51 | $3K | |
| 2022 | 43 | $613.00 | |
| 2023 | 94 | $5K | |
| 2024incomplete | 62 | $3K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 25% | 67 | 67 | $6K |
| D4910 | 23% | 69 | 69 | $5K | |
| D0150 | Comprehensive oral evaluation - new or established patient | 21% | 76 | 76 | $5K |
| D1208 | Topical application of fluoride, excluding varnish | 9.8% | 156 | 152 | $2K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 8.8% | 28 | 28 | $2K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 8.3% | 24 | 12 | $2K |
| D0210 | Intraoral - complete series of radiographic images | 2.7% | 13 | 13 | $624.00 |
| D0272 | Bitewings - two radiographic images | <1% | 13 | 13 | $148.00 |
| D0220 | Intraoral - periapical first radiographic image | <1% | 12 | 12 | $146.00 |
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 officialLEE, ETHAN (DDS)