Dental
Derek B Tom DDS LLC
Derek B Tom DDS LLC was paid $2.60M by Medicaid between Jan 2018 and Dec 2024, across 25 billing codes. Its largest line is D0120, dental checkup, returning patient — 19% of everything it billed.
33Billing provider infoDEREK B TOM DDS LLC
AIEA, HI 96701
AIEA, HI 96701
33aNPI1669826244assigned 04/20/2016
33bProvider typePediatric Dentist
28Total paid$2.60M
24GClaims98,859
24DCodes billed25
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Hawaii
Rank by total paid#5 of 35
Median peer was paid$411K
This provider vs. median6.3×
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 | |
|---|---|---|---|
| 2018 | 20,026 | $539K | |
| 2019 | 16,065 | $475K | |
| 2020 | 7,856 | $208K | |
| 2021 | 14,748 | $399K | |
| 2022 | 14,137 | $349K | |
| 2023 | 14,512 | $356K | |
| 2024incomplete | 11,515 | $268K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 19% | 17,924 | 17,924 | $487K |
| D1120 | Dental cleaning, childProphylaxis - child | 18% | 16,277 | 16,277 | $456K |
| D1206 | Topical application of fluoride varnish | 8.0% | 12,539 | 12,539 | $207K |
| D0272 | Bitewings - two radiographic images | 6.4% | 8,801 | 8,801 | $165K |
| D0330 | Panoramic radiographic image | 6.3% | 2,972 | 2,972 | $164K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 5.8% | 1,866 | 1,020 | $150K |
| D1351 | Sealant - per tooth | 5.7% | 5,354 | 1,424 | $148K |
| D0274 | Bitewings - four radiographic images | 5.1% | 4,380 | 4,380 | $132K |
| D1110 | Prophylaxis - adult | 4.5% | 2,985 | 2,985 | $116K |
| D2150 | Silver amalgam - two surfaces, primary or permanent | 4.3% | 2,203 | 1,197 | $112K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 4.0% | 1,866 | 1,811 | $104K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 2.4% | 977 | 551 | $63K |
13 more codes
| D0220 | Intraoral - periapical first radiographic image | 2.0% | 4,636 | $52K |
| D1208 | Topical application of fluoride, excluding varnish | 1.9% | 6,442 | $49K |
| D7140 | Extraction, erupted tooth or exposed root | 1.4% | 798 | $36K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 1.2% | 566 | $31K |
| D0140 | Limited oral evaluation - problem focused | 1.2% | 1,040 | $30K |
| D1354 | <1% | 3,209 | $26K | |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 2,895 | $25K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | <1% | 408 | $19K |
| D2160 | <1% | 170 | $11K | |
| D0240 | <1% | 427 | $9K | |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 78 | $3K |
| D2140 | <1% | 33 | $1K | |
| D0210 | Intraoral - complete series of radiographic images | <1% | 13 | $71.45 |
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 officialTOM, DEREK (OWNER)