Dental
Ombayo, Jacktone
Ombayo, Jacktone was paid $206K by Medicaid between Jun 2023 and Apr 2024, across 18 billing codes. Its largest line is D1351, Sealant - per tooth — 12% of everything it billed.
33Billing provider infoOMBAYO, JACKTONE
AMARILLO, TX 79106
AMARILLO, TX 79106
33aNPI1659684926assigned 07/15/2010
33bProvider typeGeneral Practice Dentistry
28Total paid$206K
24GClaims14,309
24DCodes billed18
24AFirst – last monthJun 2023 – Apr 2024
Compared with peers
Next to other General Practice Dentistry providers in Texas
Rank by total paid#814 of 2,774
Median peer was paid$43K
This provider vs. median4.8×
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 | 9,708 | $137K | |
| 2024incomplete | 4,601 | $69K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1351 | Sealant - per tooth | 12% | 1,901 | 484 | $25K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 12% | 459 | 284 | $24K |
| D1120 | Dental cleaning, childProphylaxis - child | 11% | 1,280 | 1,263 | $24K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 10% | 1,472 | 1,458 | $22K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 10% | 533 | 341 | $21K |
| D1110 | Prophylaxis - adult | 8.2% | 606 | 598 | $17K |
| D1208 | Topical application of fluoride, excluding varnish | 6.7% | 1,879 | 1,855 | $14K |
| D0145 | Oral evaluation for a patient under three years of age | 6.7% | 204 | 200 | $14K |
| D0274 | Bitewings - four radiographic images | 6.0% | 704 | 697 | $12K |
| D0272 | Bitewings - two radiographic images | 5.1% | 897 | 885 | $11K |
| D0150 | Comprehensive oral evaluation - new or established patient | 3.4% | 429 | 419 | $7K |
| D0330 | Panoramic radiographic image | 2.8% | 360 | 353 | $6K |
6 more codes
| D0220 | Intraoral - periapical first radiographic image | 2.1% | 689 | $4K |
| D0230 | Intraoral - periapical each additional radiographic image | 1.8% | 627 | $4K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | <1% | 146 | $2K |
| D0140 | Limited oral evaluation - problem focused | <1% | 38 | $328.65 |
| D0603 | 0% | 1,933 | $0.00 | |
| D0601 | 0% | 152 | $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.