Dental
Hermansjah, Lita
Hermansjah, Lita was paid $361K by Medicaid between Jan 2018 and Dec 2024, across 18 billing codes. Its largest line is D1110, Prophylaxis - adult — 16% of everything it billed.
33Billing provider infoHERMANSJAH, LITA
CORONA, CA 92882
CORONA, CA 92882
33aNPI1740367440assigned 11/01/2006
33bProvider typeDentist
28Total paid$361K
24GClaims17,852
24DCodes billed18
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Dentist providers in California
Rank by total paid#903 of 2,314
Median peer was paid$185K
This provider vs. median1.9×
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 | 2,907 | $60K | |
| 2019 | 2,684 | $55K | |
| 2020 | 2,185 | $43K | |
| 2021 | 1,467 | $23K | |
| 2022 | 2,636 | $55K | |
| 2023 | 2,998 | $62K | |
| 2024incomplete | 2,975 | $64K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 16% | 645 | 640 | $56K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 15% | 978 | 969 | $55K |
| D1120 | Dental cleaning, childProphylaxis - child | 13% | 1,203 | 1,196 | $46K |
| D9430 | 11% | 1,288 | 1,249 | $41K | |
| D0230 | Intraoral - periapical each additional radiographic image | 8.7% | 7,071 | 1,948 | $31K |
| D1208 | Topical application of fluoride, excluding varnish | 7.2% | 2,066 | 2,052 | $26K |
| D0350 | 5.5% | 1,550 | 785 | $20K | |
| D0210 | Intraoral - complete series of radiographic images | 5.5% | 426 | 421 | $20K |
| D0272 | Bitewings - two radiographic images | 4.9% | 1,489 | 1,482 | $18K |
| D2150 | Silver amalgam - two surfaces, primary or permanent | 3.7% | 198 | 104 | $13K |
| D0150 | Comprehensive oral evaluation - new or established patient | 3.5% | 209 | 208 | $13K |
| D1351 | Sealant - per tooth | 1.9% | 227 | 58 | $7K |
6 more codes
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.