1639485162

1639485162 was paid $216K by Medicaid between Jan 2018 and Jul 2018, across 23 billing codes. Its largest line is D2392, Resin-based composite - two surfaces, posterior, primary or permanent — 18% of everything it billed.

33Billing provider info1639485162

33aNPI1639485162

33bProvider type—

28Total paid$216K

24GClaims7,561

24DCodes billed23

24AFirst – last monthJan 2018 – Jul 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	7,561	$216K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	18%	615	331	$40K
D1120	Dental cleaning, childProphylaxis - child	13%	976	969	$27K
D2391	Resin-based composite - one surface, posterior, primary or permanent	10%	432	221	$22K
D0150	Comprehensive oral evaluation - new or established patient	6.9%	431	429	$15K
D0330	Panoramic radiographic image	6.5%	565	563	$14K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	6.2%	688	683	$13K
D1206	Topical application of fluoride varnish	4.8%	1,112	1,105	$10K
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	4.5%	122	81	$10K
D0210	Intraoral - complete series of radiographic images	4.5%	246	246	$10K
D1351	Sealant - per tooth	3.8%	389	117	$8K
D7140	Extraction, erupted tooth or exposed root	3.4%	131	68	$7K
D2330		3.1%	91	43	$7K

11 more codes

D9430		3.1%	243	$7K
D4341		2.5%	87	$5K
D0145	Oral evaluation for a patient under three years of age	2.0%	164	$4K
D1110	Prophylaxis - adult	1.9%	128	$4K
D0274	Bitewings - four radiographic images	1.7%	214	$4K
D1352		1.5%	176	$3K
D0272	Bitewings - two radiographic images	<1%	146	$1K
D0220	Intraoral - periapical first radiographic image	<1%	129	$1K
D0230	Intraoral - periapical each additional radiographic image	<1%	361	$1K
D0350		<1%	85	$444.00
D0270		<1%	30	$145.00

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.