Pedersen, Kyle

Pedersen, Kyle was paid $414.74 by Medicaid between Aug 2021 and Jul 2022, across 7 billing codes. Its largest line is D0120, dental checkup, returning patient — 53% of everything it billed.

33Billing provider infoPEDERSEN, KYLE
ST CHARLES, IL 60174

33aNPI1619092905assigned 03/19/2007

33bProvider typePediatric Dentist

28Total paid$414.74

24GClaims546

24DCodes billed7

24AFirst – last monthAug 2021 – Jul 2022

Compared with peers

Next to other Pediatric Dentist providers in Illinois

Rank by total paid#51 of 53

Median peer was paid$99K

This provider vs. median0.0×

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
2021	66	$0.00
2022	480	$414.74

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	53%	148	143	$218.34
D1206	Topical application of fluoride varnish	47%	192	185	$196.40
D0272	Bitewings - two radiographic images	0%	39	38	$0.00
D1120	Dental cleaning, childProphylaxis - child	0%	92	89	$0.00
D0274	Bitewings - four radiographic images	0%	31	29	$0.00
D0220	Intraoral - periapical first radiographic image	0%	19	12	$0.00
D1110	Prophylaxis - adult	0%	25	24	$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.