Dental
Daliri, Sam
Daliri, Sam was paid $650K by Medicaid between Oct 2019 and Sep 2022, across 20 billing codes. Its largest line is D1351, Sealant - per tooth — 17% of everything it billed.
33Billing provider infoDALIRI, SAM
PEACHTREE CORNERS, GA 30092
PEACHTREE CORNERS, GA 30092
33aNPI1487209664assigned 08/05/2019
33bProvider typeGeneral Practice Dentistry
28Total paid$650K
24GClaims22,423
24DCodes billed20
24AFirst – last monthOct 2019 – Sep 2022
Compared with peers
Next to other General Practice Dentistry providers in Georgia
Rank by total paid#9 of 63
Median peer was paid$30K
This provider vs. median22×
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 | 529 | $12K | |
| 2020 | 7,232 | $204K | |
| 2021 | 8,967 | $255K | |
| 2022 | 5,695 | $178K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1351 | Sealant - per tooth | 17% | 1,196 | 643 | $110K |
| D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | 16% | 1,019 | 617 | $107K |
| D1120 | Dental cleaning, childProphylaxis - child | 12% | 1,864 | 1,755 | $75K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 10% | 2,412 | 2,167 | $66K |
| D1110 | Prophylaxis - adult | 7.9% | 1,216 | 1,181 | $52K |
| D1208 | Topical application of fluoride, excluding varnish | 6.1% | 1,563 | 1,463 | $40K |
| D0274 | Bitewings - four radiographic images | 5.3% | 2,003 | 1,860 | $34K |
| D0150 | Comprehensive oral evaluation - new or established patient | 4.9% | 1,464 | 1,377 | $32K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 3.9% | 409 | 355 | $25K |
| D0230 | Intraoral - periapical each additional radiographic image | 3.8% | 3,447 | 3,038 | $25K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 3.8% | 346 | 304 | $25K |
| D0220 | Intraoral - periapical first radiographic image | 3.6% | 4,098 | 3,708 | $23K |
8 more codes
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.