1629041561

1629041561 was paid $560K by Medicaid between Jan 2018 and Jun 2018, across 20 billing codes. Its largest line is D9223, Deep sedation/general anesthesia - each subsequent 15 minute increment — 30% of everything it billed.

33Billing provider info1629041561

33aNPI1629041561

33bProvider type—

28Total paid$560K

24GClaims5,714

24DCodes billed20

24AFirst – last monthJan 2018 – Jun 2018

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	5,714	$560K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D9223	Deep sedation/general anesthesia - each subsequent 15 minute increment	30%	378	122	$166K
D2930	Prefabricated stainless steel crown - primary tooth	26%	761	175	$146K
D7140	Extraction, erupted tooth or exposed root	7.0%	453	146	$39K
D2933		6.5%	136	43	$36K
D1120	Dental cleaning, childProphylaxis - child	5.3%	602	575	$29K
D9222		4.0%	82	82	$22K
D0230	Intraoral - periapical each additional radiographic image	3.2%	734	327	$18K
D1206	Topical application of fluoride varnish	2.7%	578	553	$15K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	2.5%	396	383	$14K
D0220	Intraoral - periapical first radiographic image	1.8%	462	435	$10K
D0140	Limited oral evaluation - problem focused	1.8%	194	183	$10K
D2391	Resin-based composite - one surface, posterior, primary or permanent	1.8%	80	58	$10K

8 more codes

D1351	Sealant - per tooth	1.7%	241	$10K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	1.3%	50	$7K
D0272	Bitewings - two radiographic images	1.2%	188	$7K
D0150	Comprehensive oral evaluation - new or established patient	1.0%	100	$6K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	<1%	129	$5K
D0145	Oral evaluation for a patient under three years of age	<1%	94	$4K
D3220	Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction	<1%	22	$3K
D0330	Panoramic radiographic image	<1%	34	$3K

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.