Louie, Jack

Louie, Jack was paid $6K by Medicaid between Oct 2019 and Mar 2020, across 4 billing codes. Its largest line is D1208, Topical application of fluoride, excluding varnish — 34% of everything it billed.

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	175	$4K
2020	96	$2K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1208	Topical application of fluoride, excluding varnish	34%	118	118	$2K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	30%	86	86	$2K
D1120	Dental cleaning, childProphylaxis - child	28%	54	54	$2K
D1110	Prophylaxis - adult	7.9%	13	13	$506.00

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.