Petersen, Carly

Petersen, Carly was paid $2K by Medicaid between Jan 2022 and Feb 2022, across 7 billing codes. Its largest line is D1110, Prophylaxis - adult — 30% of everything it billed.

33Billing provider infoPETERSEN, CARLY
LAKE OSWEGO, OR 97035

33aNPI1841844354assigned 08/01/2019

33bProvider typeGeneral Practice Dentistry

28Total paid$2K

24GClaims221

24DCodes billed7

24AFirst – last monthJan 2022 – Feb 2022

Compared with peers

Next to other General Practice Dentistry providers in Oregon

Rank by total paid#199 of 311

Median peer was paid$6K

This provider vs. median0.3×

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
2022	221	$2K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1110	Prophylaxis - adult	30%	32	32	$658.00
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	18%	39	39	$392.00
D1206	Topical application of fluoride varnish	15%	37	37	$323.00
D0220	Intraoral - periapical first radiographic image	11%	40	38	$247.00
D0140	Limited oral evaluation - problem focused	9.5%	13	12	$210.00
D0274	Bitewings - four radiographic images	9.1%	19	19	$203.00
D0230	Intraoral - periapical each additional radiographic image	8.5%	41	32	$189.00

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.