1639173503

1639173503 was paid $64K by Medicaid between Jan 2018 and Feb 2020, across 10 billing codes. Its largest line is D4212, — 22% of everything it billed.

33Billing provider info1639173503

33aNPI1639173503

33bProvider type—

28Total paid$64K

24GClaims2,627

24DCodes billed10

24AFirst – last monthJan 2018 – Feb 2020

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	1,239	$9K
2019	1,157	$42K
2020	231	$13K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D4212		22%	51	43	$14K
D1110	Prophylaxis - adult	18%	396	379	$11K
D9920		15%	468	353	$10K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	13%	493	403	$8K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	7.9%	364	349	$5K
D0140	Limited oral evaluation - problem focused	6.9%	207	199	$4K
D1208	Topical application of fluoride, excluding varnish	6.0%	308	290	$4K
D2931		5.5%	28	25	$4K
D0220	Intraoral - periapical first radiographic image	3.2%	300	284	$2K
D3330	Endodontic therapy, molar tooth (excluding final restoration)	2.7%	12	12	$2K

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.