1619038742

1619038742 was paid $385K by Medicaid between Jan 2018 and Mar 2021, across 18 billing codes. Its largest line is D1110, Prophylaxis - adult — 20% of everything it billed.

33Billing provider info1619038742

33aNPI1619038742

33bProvider type—

28Total paid$385K

24GClaims19,328

24DCodes billed18

24AFirst – last monthJan 2018 – Mar 2021

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	6,083	$28K
2019	7,561	$183K
2020	4,815	$147K
2021	869	$27K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1110	Prophylaxis - adult	20%	2,771	2,135	$76K
D4212		13%	213	77	$50K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	11%	3,203	2,437	$42K
D0274	Bitewings - four radiographic images	9.6%	1,845	1,368	$37K
D0140	Limited oral evaluation - problem focused	7.7%	1,381	923	$30K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	6.4%	529	264	$25K
D0330	Panoramic radiographic image	5.3%	856	595	$21K
D1208	Topical application of fluoride, excluding varnish	5.1%	1,866	1,393	$19K
D0150	Comprehensive oral evaluation - new or established patient	3.6%	782	590	$14K
D1120	Dental cleaning, childProphylaxis - child	3.4%	908	680	$13K
D0210	Intraoral - complete series of radiographic images	2.9%	687	441	$11K
D0220	Intraoral - periapical first radiographic image	2.6%	1,611	1,145	$10K

6 more codes

D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	2.3%	1,306	$9K
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth	2.3%	45	$9K
D2150	Silver amalgam - two surfaces, primary or permanent	2.2%	250	$9K
D2391	Resin-based composite - one surface, posterior, primary or permanent	2.0%	167	$8K
D0230	Intraoral - periapical each additional radiographic image	<1%	834	$4K
D0272	Bitewings - two radiographic images	<1%	74	$49.62

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.