1487667796

1487667796 was paid $615K by Medicaid between Jan 2018 and Dec 2019, across 14 billing codes. Its largest line is D2393, Resin-based composite - three surfaces, posterior, primary or permanent — 43% of everything it billed.

33Billing provider info1487667796

33aNPI1487667796

33bProvider type—

28Total paid$615K

24GClaims18,995

24DCodes billed14

24AFirst – last monthJan 2018 – Dec 2019

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	11,114	$375K
2019	7,881	$240K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	43%	4,075	675	$262K
D2940		32%	7,473	1,660	$196K
D0210	Intraoral - complete series of radiographic images	5.4%	788	770	$33K
D1110	Prophylaxis - adult	2.9%	689	674	$18K
D0150	Comprehensive oral evaluation - new or established patient	2.5%	792	772	$15K
D4355		2.5%	228	221	$15K
D1208	Topical application of fluoride, excluding varnish	2.4%	1,222	1,202	$15K
D0140	Limited oral evaluation - problem focused	2.4%	750	741	$14K
D1120	Dental cleaning, childProphylaxis - child	1.7%	486	480	$10K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	1.5%	167	30	$9K
D0272	Bitewings - two radiographic images	1.4%	704	692	$9K
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth	<1%	74	41	$6K

2 more codes

D0220	Intraoral - periapical first radiographic image	<1%	780	$6K
D0230	Intraoral - periapical each additional radiographic image	<1%	767	$4K

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.