Dental
Redjo - Setyono, Mellisri
Redjo - Setyono, Mellisri was paid $2.20M by Medicaid between Jan 2018 and Dec 2024, across 25 billing codes. Its largest line is D2751, Crown - porcelain fused to predominantly base metal — 36% of everything it billed.
33Billing provider infoREDJO - SETYONO, MELLISRI
LOS ANGELES, CA 90017
LOS ANGELES, CA 90017
33aNPI1598803801assigned 02/01/2007
33bProvider typeGeneral Practice Dentistry
28Total paid$2.20M
24GClaims35,626
24DCodes billed25
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other General Practice Dentistry providers in California
Rank by total paid#265 of 2,668
Median peer was paid$173K
This provider vs. median13×
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 | 5,927 | $271K | |
| 2019 | 5,080 | $322K | |
| 2020 | 3,899 | $199K | |
| 2021 | 4,186 | $201K | |
| 2022 | 4,821 | $283K | |
| 2023 | 5,344 | $448K | |
| 2024incomplete | 6,369 | $473K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2751 | Crown - porcelain fused to predominantly base metal | 36% | 1,685 | 1,054 | $801K |
| D3330 | Endodontic therapy, molar tooth (excluding final restoration) | 19% | 890 | 752 | $408K |
| D2954 | 12% | 2,466 | 1,671 | $254K | |
| D0150 | Comprehensive oral evaluation - new or established patient | 6.4% | 2,261 | 2,257 | $141K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 6.1% | 2,623 | 2,617 | $134K |
| D1110 | Prophylaxis - adult | 5.5% | 1,437 | 1,431 | $121K |
| D0274 | Bitewings - four radiographic images | 2.8% | 3,007 | 3,003 | $61K |
| D0230 | Intraoral - periapical each additional radiographic image | 2.7% | 15,397 | 3,655 | $60K |
| D1120 | Dental cleaning, childProphylaxis - child | 1.7% | 1,129 | 1,129 | $38K |
| D1208 | Topical application of fluoride, excluding varnish | 1.2% | 2,103 | 2,098 | $27K |
| D3320 | 1.1% | 69 | 56 | $25K | |
| D4341 | 1.1% | 347 | 105 | $24K |
13 more codes
| D2931 | 1.0% | 183 | $23K | |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | <1% | 369 | $19K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | <1% | 210 | $14K |
| D4910 | <1% | 177 | $14K | |
| D9430 | <1% | 326 | $10K | |
| D3310 | <1% | 21 | $6K | |
| D1351 | Sealant - per tooth | <1% | 294 | $6K |
| D1206 | Topical application of fluoride varnish | <1% | 372 | $4K |
| D0210 | Intraoral - complete series of radiographic images | <1% | 77 | $3K |
| D2150 | Silver amalgam - two surfaces, primary or permanent | <1% | 33 | $2K |
| D4342 | <1% | 37 | $2K | |
| D0220 | Intraoral - periapical first radiographic image | <1% | 101 | $985.00 |
| D0270 | <1% | 12 | $60.00 |
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.