Dental
Setiawan, Grace
Setiawan, Grace was paid $3K by Medicaid between Jul 2023 and Mar 2024, across 6 billing codes. Its largest line is D0145, Oral evaluation for a patient under three years of age — 66% of everything it billed.
33Billing provider infoSETIAWAN, GRACE
MESQUITE, TX 75150
MESQUITE, TX 75150
33aNPI1659524452assigned 10/24/2008
33bProvider typeDentist
28Total paid$3K
24GClaims216
24DCodes billed6
24AFirst – last monthJul 2023 – Mar 2024
Compared with peers
Next to other Dentist providers in Texas
Rank by total paid#1,286 of 1,678
Median peer was paid$35K
This provider vs. median0.1×
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 | |
|---|---|---|---|
| 2023 | 141 | $758.59 | |
| 2024incomplete | 75 | $2K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0145 | Oral evaluation for a patient under three years of age | 66% | 14 | 14 | $2K |
| D0230 | Intraoral - periapical each additional radiographic image | 15% | 44 | 12 | $416.77 |
| D1208 | Topical application of fluoride, excluding varnish | 13% | 25 | 25 | $367.50 |
| D0220 | Intraoral - periapical first radiographic image | 5.4% | 12 | 12 | $150.72 |
| D1999 | 0% | 27 | 27 | $0.00 | |
| D0603 | 0% | 94 | 89 | $0.00 |
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.