1568426336

1568426336 was paid $764K by Medicaid between Feb 2019 and Aug 2020, across 8 billing codes. Its largest line is D9420, — 55% of everything it billed.

33Billing provider info1568426336

33aNPI1568426336

33bProvider type—

28Total paid$764K

24GClaims1,094

24DCodes billed8

24AFirst – last monthFeb 2019 – Aug 2020

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	797	$526K
2020	297	$238K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D9420		55%	409	383	$421K
41899	Unlisted procedure, dentoalveolar structures	45%	409	330	$343K
D0220	Intraoral - periapical first radiographic image	0%	41	32	$0.00
D2930	Prefabricated stainless steel crown - primary tooth	0%	62	52	$0.00
D7250		0%	50	32	$0.00
D3220	Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction	0%	40	32	$0.00
D0230	Intraoral - periapical each additional radiographic image	0%	45	36	$0.00
D2330		0%	38	28	$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.