Dental
Pribadi, Darmawan
Pribadi, Darmawan was paid $62K by Medicaid between Jan 2018 and Aug 2024, across 8 billing codes. Its largest line is D0120, dental checkup, returning patient — 33% of everything it billed.
33Billing provider infoPRIBADI, DARMAWAN
POMONA, CA 91766
POMONA, CA 91766
33aNPI1508908534assigned 02/13/2007
33bProvider typeDentist
28Total paid$62K
24GClaims2,819
24DCodes billed8
24AFirst – last monthJan 2018 – Aug 2024
Compared with peers
Next to other Dentist providers in California
Rank by total paid#1,503 of 2,314
Median peer was paid$185K
This provider vs. median0.3×
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 | |
|---|---|---|---|
| 2018 | 569 | $10K | |
| 2019 | 754 | $16K | |
| 2020 | 433 | $10K | |
| 2021 | 410 | $8K | |
| 2022 | 351 | $11K | |
| 2023 | 119 | $2K | |
| 2024incomplete | 183 | $4K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 33% | 412 | 410 | $20K |
| D1110 | Prophylaxis - adult | 20% | 155 | 155 | $12K |
| D0230 | Intraoral - periapical each additional radiographic image | 18% | 1,158 | 1,134 | $11K |
| D0272 | Bitewings - two radiographic images | 14% | 733 | 730 | $9K |
| D1120 | Dental cleaning, childProphylaxis - child | 9.5% | 199 | 199 | $6K |
| D1351 | Sealant - per tooth | 2.6% | 74 | 14 | $2K |
| D0150 | Comprehensive oral evaluation - new or established patient | 1.5% | 14 | 14 | $924.00 |
| D0220 | Intraoral - periapical first radiographic image | 1.4% | 74 | 69 | $854.00 |
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.