1619015476

1619015476 was paid $434K by Medicaid between Jan 2018 and Jun 2023, across 12 billing codes. Its largest line is D1110, Prophylaxis - adult — 40% of everything it billed.

33Billing provider info1619015476

33aNPI1619015476

33bProvider type—

28Total paid$434K

24GClaims13,775

24DCodes billed12

24AFirst – last monthJan 2018 – Jun 2023

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	2,978	$100K
2019	3,038	$95K
2020	2,065	$67K
2021	2,439	$75K
2022	2,428	$72K
2023	827	$24K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1110	Prophylaxis - adult	40%	3,558	3,545	$174K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	25%	4,203	4,175	$107K
D0274	Bitewings - four radiographic images	19%	3,340	3,322	$84K
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth	4.9%	258	167	$21K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	3.2%	174	137	$14K
D0220	Intraoral - periapical first radiographic image	3.0%	1,156	1,148	$13K
D0140	Limited oral evaluation - problem focused	2.4%	785	783	$11K
D0210	Intraoral - complete series of radiographic images	1.9%	177	177	$8K
D2391	Resin-based composite - one surface, posterior, primary or permanent	<1%	37	30	$2K
D9920		<1%	13	13	$203.00
D9110		<1%	12	12	$184.04
00120		0%	62	62	$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.