1649332305

1649332305 was paid $855K by Medicaid between Jan 2018 and Jun 2023, across 19 billing codes. Its largest line is D1110, Prophylaxis - adult — 20% of everything it billed.

33Billing provider info1649332305

33aNPI1649332305

33bProvider type—

28Total paid$855K

24GClaims17,437

24DCodes billed19

24AFirst – last monthJan 2018 – Jun 2023

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	1,323	$37K
2019	1,362	$55K
2020	3,835	$153K
2021	4,531	$202K
2022	4,424	$275K
2023	1,962	$134K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1110	Prophylaxis - adult	20%	1,976	1,964	$170K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	19%	2,991	2,971	$163K
D0150	Comprehensive oral evaluation - new or established patient	9.9%	1,314	1,308	$85K
D1120	Dental cleaning, childProphylaxis - child	8.3%	1,902	1,893	$71K
D2751	Crown - porcelain fused to predominantly base metal	8.1%	146	113	$69K
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth	7.2%	536	240	$62K
D0210	Intraoral - complete series of radiographic images	6.0%	1,089	1,084	$51K
D1208	Topical application of fluoride, excluding varnish	5.9%	3,967	3,945	$50K
D3330	Endodontic therapy, molar tooth (excluding final restoration)	4.2%	77	66	$36K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	3.2%	415	242	$28K
D0220	Intraoral - periapical first radiographic image	2.5%	1,812	1,790	$21K
D1351	Sealant - per tooth	1.8%	619	121	$15K

7 more codes

D2954		1.6%	134	$14K
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	1.3%	137	$11K
D3221		<1%	58	$4K
D0274	Bitewings - four radiographic images	<1%	116	$2K
D2391	Resin-based composite - one surface, posterior, primary or permanent	<1%	36	$2K
D7140	Extraction, erupted tooth or exposed root	<1%	19	$1K
D0230	Intraoral - periapical each additional radiographic image	<1%	93	$567.00

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.