Clinic
Boulevard Dental Clinic
Boulevard Dental Clinic was paid $519.09 by Medicaid between Jun 2022 and Aug 2023, across 1 billing code. Its largest line is D1110, Prophylaxis - adult — 100% of everything it billed.
33Billing provider infoBOULEVARD DENTAL CLINIC
FAIRFAX, VA 22031
FAIRFAX, VA 22031
33aNPI1639346182assigned 05/14/2008
33bProvider typeDental Clinic/Center
28Total paid$519.09
24GClaims24
24DCodes billed1
24AFirst – last monthJun 2022 – Aug 2023
Compared with peers
Next to other Dental Clinic/Center providers in Virginia
Rank by total paid#120 of 142
Median peer was paid$75K
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 | |
|---|---|---|---|
| 2022 | 12 | $519.09 | |
| 2023 | 12 | $0.00 |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 100% | 24 | 24 | $519.09 |
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.
From NPPES
Who's on the registration
Authorized officialGAITAN, RICARDO (GENERAL DENTIST)
| Provider | Location | Paid |
|---|---|---|
| DR. Ricardo Gaitan | Sterling, VA | $6K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.