Home ›
NPI 1497171680
NPI deactivated
1497171680
1497171680 was paid $5.79M by Medicaid between Jan 2018 and Dec 2021, across 39 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 14% of everything it billed.
33Billing provider info1497171680
33aNPI1497171680
33bProvider type—
28Total paid$5.79M
24GClaims154,963
24DCodes billed39
24AFirst – last monthJan 2018 – Dec 2021
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 | 33,861 | $1.30M | |
| 2019 | 38,762 | $1.46M | |
| 2020 | 39,021 | $1.42M | |
| 2021 | 43,319 | $1.60M |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 14% | 8,504 | 2,997 | $829K |
| D1120 | Dental cleaning, childProphylaxis - child | 9.7% | 17,655 | 16,958 | $562K |
| D7140 | Extraction, erupted tooth or exposed root | 8.7% | 8,891 | 3,925 | $503K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 8.1% | 6,985 | 4,030 | $469K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 7.4% | 18,831 | 18,110 | $428K |
| D8670 | Periodic orthodontic treatment visit | 7.1% | 4,418 | 4,275 | $408K |
| D1206 | Topical application of fluoride varnish | 6.5% | 19,479 | 18,688 | $379K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 6.0% | 6,257 | 3,896 | $346K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 4.2% | 8,927 | 8,397 | $245K |
| D1110 | Prophylaxis - adult | 3.6% | 5,287 | 5,065 | $211K |
| D1351 | Sealant - per tooth | 3.5% | 8,192 | 2,755 | $204K |
| D0210 | Intraoral - complete series of radiographic images | 3.2% | 3,635 | 3,463 | $184K |
27 more codes
| D9248 | 2.9% | 2,139 | $166K | |
| D0272 | Bitewings - two radiographic images | 2.2% | 8,868 | $127K |
| D0274 | Bitewings - four radiographic images | 1.6% | 4,076 | $92K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 1.5% | 1,242 | $87K |
| D0150 | Comprehensive oral evaluation - new or established patient | 1.3% | 2,730 | $73K |
| D8080 | Comprehensive orthodontic treatment of the adolescent dentition | 1.1% | 54 | $61K |
| D2330 | <1% | 1,052 | $54K | |
| D1208 | Topical application of fluoride, excluding varnish | <1% | 2,978 | $54K |
| D0220 | Intraoral - periapical first radiographic image | <1% | 4,237 | $45K |
| D8660 | <1% | 1,021 | $44K | |
| D2929 | <1% | 473 | $40K | |
| D0140 | Limited oral evaluation - problem focused | <1% | 1,439 | $29K |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 1,257 | $27K |
| D2332 | <1% | 322 | $24K | |
| D1510 | <1% | 181 | $24K | |
| D3230 | <1% | 226 | $12K | |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | <1% | 129 | $11K |
| D2390 | <1% | 80 | $11K | |
| D0330 | Panoramic radiographic image | <1% | 276 | $11K |
| D2331 | <1% | 134 | $7K | |
| D2931 | <1% | 48 | $6K | |
| D1517 | <1% | 35 | $6K | |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 663 | $5K |
| D9110 | <1% | 15 | $633.75 | |
| D1354 | <1% | 104 | $553.85 | |
| D9420 | 0% | 92 | $0.00 | |
| D1999 | 0% | 4,031 | $0.00 |
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.