Dental
Vidales, Mateo
Vidales, Mateo was paid $70K by Medicaid between Jul 2023 and Dec 2024, across 15 billing codes. Its largest line is D2392, Resin-based composite - two surfaces, posterior, primary or permanent — 25% of everything it billed.
33Billing provider infoVIDALES, MATEO
DAVENPORT, FL 33896
DAVENPORT, FL 33896
33aNPI1871086405assigned 06/08/2018
33bProvider typeDentist
28Total paid$70K
24GClaims3,134
24DCodes billed15
24AFirst – last monthJul 2023 – Dec 2024
Compared with peers
Next to other Dentist providers in Florida
Rank by total paid#202 of 542
Median peer was paid$25K
This provider vs. median2.8×
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 | 938 | $27K | |
| 2024incomplete | 2,196 | $44K |
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 | 25% | 503 | 268 | $18K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 18% | 189 | 114 | $12K |
| D0330 | Panoramic radiographic image | 15% | 346 | 342 | $10K |
| D1110 | Prophylaxis - adult | 12% | 385 | 384 | $8K |
| D0210 | Intraoral - complete series of radiographic images | 11% | 157 | 157 | $8K |
| D0150 | Comprehensive oral evaluation - new or established patient | 8.0% | 619 | 615 | $6K |
| D1206 | Topical application of fluoride varnish | 3.5% | 355 | 352 | $2K |
| D2332 | 3.0% | 44 | 26 | $2K | |
| D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | 2.8% | 62 | 29 | $2K |
| D0274 | Bitewings - four radiographic images | <1% | 97 | 97 | $610.62 |
| D0220 | Intraoral - periapical first radiographic image | <1% | 160 | 154 | $264.56 |
| D1330 | <1% | 53 | 53 | $189.18 |
3 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.