Clinic
The Wallace Medical Concern
The Wallace Medical Concern was paid $496K by Medicaid between Oct 2021 and Dec 2024, across 26 billing codes. Its largest line is D1110, Prophylaxis - adult — 20% of everything it billed.
33Billing provider infoTHE WALLACE MEDICAL CONCERN
PORTLAND, OR 97233
PORTLAND, OR 97233
33aNPI1558033118assigned 10/01/2021
33bProvider typeDental Clinic/Center
28Total paid$496K
24GClaims19,363
24DCodes billed26
24AFirst – last monthOct 2021 – Dec 2024
Compared with peers
Next to other Dental Clinic/Center providers in Oregon
Rank by total paid#13 of 39
Median peer was paid$86K
This provider vs. median5.7×
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 | |
|---|---|---|---|
| 2021 | 367 | $9K | |
| 2022 | 2,803 | $65K | |
| 2023 | 5,794 | $137K | |
| 2024incomplete | 10,399 | $285K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 20% | 1,711 | 1,670 | $97K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 17% | 2,344 | 2,289 | $85K |
| D1206 | Topical application of fluoride varnish | 13% | 3,228 | 3,111 | $64K |
| D0150 | Comprehensive oral evaluation - new or established patient | 9.1% | 851 | 814 | $45K |
| D0274 | Bitewings - four radiographic images | 7.7% | 1,821 | 1,776 | $38K |
| D1120 | Dental cleaning, childProphylaxis - child | 7.0% | 801 | 760 | $35K |
| D4341 | 5.7% | 313 | 256 | $28K | |
| D0210 | Intraoral - complete series of radiographic images | 4.0% | 454 | 440 | $20K |
| D4346 | 2.7% | 195 | 193 | $14K | |
| D4342 | 2.6% | 185 | 145 | $13K | |
| D4910 | 2.4% | 257 | 246 | $12K | |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 2.3% | 178 | 147 | $11K |
14 more codes
| D7140 | Extraction, erupted tooth or exposed root | 2.1% | 82 | $11K |
| D0220 | Intraoral - periapical first radiographic image | 1.5% | 523 | $8K |
| D0140 | Limited oral evaluation - problem focused | 1.5% | 151 | $8K |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 385 | $3K |
| D0272 | Bitewings - two radiographic images | <1% | 93 | $2K |
| D0330 | Panoramic radiographic image | <1% | 27 | $869.86 |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | <1% | 18 | $778.54 |
| D0240 | <1% | 59 | $450.00 | |
| D0603 | <1% | 1,103 | $261.00 | |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | <1% | 12 | $157.20 |
| D0601 | <1% | 276 | $40.00 | |
| D0602 | <1% | 163 | $12.00 | |
| D1330 | <1% | 2,356 | $1.40 | |
| D1310 | 0% | 1,777 | $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.
From NPPES
Who's on the registration
Authorized officialSIRIANNI, MICHELLE (EA & FEDERAL GRANTS PROGRAM MANAGER)