Dental
Sebastian Bouroncle DDS-1 PLLC
Sebastian Bouroncle DDS-1 PLLC was paid $866K by Medicaid between Jan 2018 and Sep 2024, across 26 billing codes. Its largest line is D2392, Resin-based composite - two surfaces, posterior, primary or permanent — 18% of everything it billed.
33Billing provider infoSEBASTIAN BOURONCLE DDS-1 PLLC
WOODBRIDGE, VA 22191
WOODBRIDGE, VA 22191
33aNPI1740667799assigned 04/29/2015
33bProvider typeDentist
28Total paid$866K
24GClaims23,915
24DCodes billed26
24AFirst – last monthJan 2018 – Sep 2024
Compared with peers
Next to other Dentist providers in Virginia
Rank by total paid#40 of 417
Median peer was paid$34K
This provider vs. median26×
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 | 501 | $13K | |
| 2019 | 702 | $13K | |
| 2020 | 652 | $9K | |
| 2021 | 2,457 | $121K | |
| 2022 | 7,364 | $511K | |
| 2023 | 7,905 | $199K | |
| 2024incomplete | 4,334 | $0.00 |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 18% | 2,319 | 1,144 | $159K |
| D2740 | Crown - porcelain/ceramic | 18% | 551 | 383 | $153K |
| D1110 | Prophylaxis - adult | 8.3% | 2,144 | 2,101 | $72K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 7.0% | 609 | 374 | $60K |
| D2950 | 6.7% | 659 | 513 | $58K | |
| D0210 | Intraoral - complete series of radiographic images | 5.8% | 978 | 871 | $50K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 4.4% | 587 | 359 | $38K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 4.2% | 2,638 | 2,583 | $37K |
| D0150 | Comprehensive oral evaluation - new or established patient | 4.2% | 1,500 | 1,400 | $37K |
| D9610 | 4.0% | 2,549 | 2,386 | $34K | |
| D0274 | Bitewings - four radiographic images | 2.8% | 1,318 | 1,281 | $24K |
| D1208 | Topical application of fluoride, excluding varnish | 2.4% | 1,334 | 1,315 | $21K |
14 more codes
| D0220 | Intraoral - periapical first radiographic image | 2.3% | 2,616 | $20K |
| D1120 | Dental cleaning, child | 2.1% | 646 | $18K |
| D4910 | 2.0% | 509 | $17K | |
| D3320 | 1.5% | 31 | $13K | |
| D0230 | Intraoral - periapical each additional radiographic image | 1.5% | 1,710 | $13K |
| D0140 | Limited oral evaluation - problem focused | 1.4% | 711 | $12K |
| D3330 | Endodontic therapy, molar tooth (excluding final restoration) | 1.2% | 32 | $11K |
| D1351 | Sealant - per tooth | <1% | 114 | $5K |
| D4355 | <1% | 57 | $4K | |
| D9920 | <1% | 62 | $4K | |
| D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | <1% | 24 | $3K |
| D2394 | <1% | 15 | $2K | |
| D2331 | <1% | 14 | $1K | |
| D4341 | 0% | 188 | $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.
From NPPES
Who's on the registration
Authorized officialDE CASTRO, VIRGINIA (OFFICE MANAGER)