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NPI 1609316801
NPI deactivated
1609316801
1609316801 was paid $2.18M by Medicaid between Jan 2018 and Jan 2022, across 29 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 18% of everything it billed.
33Billing provider info1609316801
33aNPI1609316801
33bProvider type—
28Total paid$2.18M
24GClaims61,382
24DCodes billed29
24AFirst – last monthJan 2018 – Jan 2022
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 | 5,079 | $201K | |
| 2019 | 15,873 | $671K | |
| 2020 | 18,095 | $612K | |
| 2021 | 22,146 | $688K | |
| 2022 | 189 | $4K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 18% | 3,858 | 1,323 | $396K |
| D1120 | Dental cleaning, childProphylaxis - child | 12% | 8,726 | 8,232 | $270K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 11% | 3,542 | 1,661 | $239K |
| D7140 | Extraction, erupted tooth or exposed root | 8.0% | 3,061 | 1,326 | $175K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 6.6% | 6,524 | 6,160 | $144K |
| D9248 | 5.6% | 1,551 | 1,366 | $121K | |
| D1208 | Topical application of fluoride, excluding varnish | 5.2% | 6,144 | 5,838 | $114K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 4.6% | 1,823 | 1,054 | $101K |
| D0150 | Comprehensive oral evaluation - new or established patient | 4.5% | 3,700 | 3,473 | $98K |
| D1206 | Topical application of fluoride varnish | 3.3% | 3,856 | 3,577 | $72K |
| D0210 | Intraoral - complete series of radiographic images | 3.1% | 1,479 | 1,361 | $67K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 3.0% | 2,367 | 2,156 | $64K |
17 more codes
| D8670 | Periodic orthodontic treatment visit | 2.9% | 725 | $64K |
| D0272 | Bitewings - two radiographic images | 2.3% | 3,989 | $51K |
| D1110 | Prophylaxis - adult | 2.2% | 1,235 | $49K |
| D1351 | Sealant - per tooth | 1.8% | 1,644 | $39K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 1.5% | 430 | $33K |
| D0220 | Intraoral - periapical first radiographic image | 1.3% | 2,555 | $29K |
| D0140 | Limited oral evaluation - problem focused | <1% | 801 | $17K |
| D0274 | Bitewings - four radiographic images | <1% | 665 | $12K |
| D0330 | Panoramic radiographic image | <1% | 177 | $6K |
| D2929 | <1% | 37 | $4K | |
| D8660 | <1% | 97 | $4K | |
| D3230 | <1% | 49 | $3K | |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 132 | $3K |
| D2330 | <1% | 19 | $1K | |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 95 | $747.29 |
| D1354 | <1% | 77 | $362.62 | |
| D1999 | 0% | 2,024 | $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.