Davidson, Samuel

Davidson, Samuel was paid $29K by Medicaid between Aug 2023 and Dec 2024, across 11 billing codes. Its largest line is D0120, dental checkup, returning patient — 21% of everything it billed.

33Billing provider infoDAVIDSON, SAMUEL
GREYBULL, WY 82426

33aNPI1861060444assigned 06/11/2021

33bProvider typeGeneral Practice Dentistry

28Total paid$29K

24GClaims709

24DCodes billed11

24AFirst – last monthAug 2023 – Dec 2024

Compared with peers

Next to other General Practice Dentistry providers in Wyoming

Rank by total paid#18 of 64

Median peer was paid$6K

This provider vs. median4.7×

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
2023	154	$6K
2024incomplete	555	$23K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	21%	197	184	$6K
D0140	Limited oral evaluation - problem focused	18%	108	104	$5K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	16%	41	25	$5K
D1120	Dental cleaning, childProphylaxis - child	13%	114	108	$4K
D1110	Prophylaxis - adult	10%	61	57	$3K
D1206	Topical application of fluoride varnish	7.4%	61	59	$2K
D0330	Panoramic radiographic image	5.5%	29	28	$2K
D0274	Bitewings - four radiographic images	5.4%	44	41	$2K
D0150	Comprehensive oral evaluation - new or established patient	1.7%	13	12	$511.92
D0272	Bitewings - two radiographic images	<1%	15	12	$292.50
D1330		<1%	26	26	$182.85

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.