Lee, Samantha

Lee, Samantha was paid $9K by Medicaid between Jun 2021 and Jun 2023, across 6 billing codes. Its largest line is D1110, Prophylaxis - adult — 35% of everything it billed.

33Billing provider infoLEE, SAMANTHA
ELKHART, IN 46514

33aNPI1790395200assigned 08/10/2020

33bProvider typeDentist

28Total paid$9K

24GClaims218

24DCodes billed6

24AFirst – last monthJun 2021 – Jun 2023

Compared with peers

Next to other Dentist providers in Indiana

Rank by total paid#310 of 452

Median peer was paid$59K

This provider vs. median0.1×

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
2021	14	$566.23
2023	204	$8K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1110	Prophylaxis - adult	35%	58	58	$3K
D2150	Silver amalgam - two surfaces, primary or permanent	27%	26	17	$2K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	17%	63	63	$2K
D0274	Bitewings - four radiographic images	12%	29	29	$1K
D1208	Topical application of fluoride, excluding varnish	4.4%	19	19	$380.63
D0220	Intraoral - periapical first radiographic image	4.2%	23	23	$367.12

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.