1699895706

1699895706 was paid $1.35M by Medicaid between Jan 2018 and Dec 2024, across 20 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 47% of everything it billed.

33Billing provider info1699895706

33aNPI1699895706

33bProvider type—

28Total paid$1.35M

24GClaims35,626

24DCodes billed20

24AFirst – last monthJan 2018 – Dec 2024

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	4,754	$225K
2019	7,709	$380K
2020	6,669	$250K
2021	6,162	$180K
2022	2,910	$87K
2023	3,924	$116K
2024incomplete	3,498	$114K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D2930	Prefabricated stainless steel crown - primary tooth	47%	5,870	1,087	$633K
D1120	Dental cleaning, childProphylaxis - child	11%	5,233	5,221	$143K
D7140	Extraction, erupted tooth or exposed root	8.9%	2,376	848	$121K
D1110	Prophylaxis - adult	8.9%	3,661	3,654	$120K
D1206	Topical application of fluoride varnish	7.6%	4,466	4,459	$103K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	6.0%	5,283	5,273	$82K
D2390		3.0%	622	202	$40K
D1208	Topical application of fluoride, excluding varnish	2.3%	3,536	3,527	$31K
D3220	Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction	1.3%	216	103	$18K
D0272	Bitewings - two radiographic images	1.3%	1,799	1,789	$18K
D0330	Panoramic radiographic image	1.3%	805	803	$17K
D1351	Sealant - per tooth	<1%	561	166	$10K

8 more codes

D2391	Resin-based composite - one surface, posterior, primary or permanent	<1%	160	$6K
D9997		<1%	172	$5K
D0274	Bitewings - four radiographic images	<1%	187	$4K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	<1%	119	$3K
D0140	Limited oral evaluation - problem focused	<1%	124	$816.20
D0220	Intraoral - periapical first radiographic image	<1%	13	$37.40
D9995		0%	19	$0.00
D1999		0%	404	$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.