Moore, Ethan

Moore, Ethan was paid $37K by Medicaid between May 2024 and Nov 2024, across 10 billing codes. Its largest line is D0210, Intraoral - complete series of radiographic images — 20% of everything it billed.

33Billing provider infoMOORE, ETHAN
COLUMBIA, MS 39429

33aNPI1710555115assigned 06/14/2021

33bProvider typeGeneral Practice Dentistry

28Total paid$37K

24GClaims1,139

24DCodes billed10

24AFirst – last monthMay 2024 – Nov 2024

Compared with peers

Next to other General Practice Dentistry providers in Mississippi

Rank by total paid#232 of 379

Median peer was paid$78K

This provider vs. median0.5×

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
2024incomplete	1,139	$37K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D0210	Intraoral - complete series of radiographic images	20%	104	101	$7K
D1351	Sealant - per tooth	17%	221	25	$6K
D1120	Dental cleaning, childProphylaxis - child	17%	204	199	$6K
D1206	Topical application of fluoride varnish	16%	221	213	$6K
D0140	Limited oral evaluation - problem focused	12%	111	103	$5K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	8.8%	113	111	$3K
D0220	Intraoral - periapical first radiographic image	3.3%	96	92	$1K
D0150	Comprehensive oral evaluation - new or established patient	3.1%	30	29	$1K
D0274	Bitewings - four radiographic images	1.7%	18	18	$626.22
D0230	Intraoral - periapical each additional radiographic image	<1%	21	21	$290.43

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.