Dental
Gustafson, David
Gustafson, David was paid $168K by Medicaid between Aug 2018 and Nov 2024, across 11 billing codes. Its largest line is D0120, dental checkup, returning patient — 24% of everything it billed.
33Billing provider infoGUSTAFSON, DAVID
SALT LAKE CITY, UT 84117
SALT LAKE CITY, UT 84117
33aNPI1871783027assigned 07/25/2007
33bProvider typePediatric Dentist
28Total paid$168K
24GClaims5,620
24DCodes billed11
24AFirst – last monthAug 2018 – Nov 2024
Compared with peers
Next to other Pediatric Dentist providers in Utah
Rank by total paid#99 of 152
Median peer was paid$311K
This provider vs. median0.5×
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 | 121 | $3K | |
| 2019 | 915 | $24K | |
| 2020 | 1,353 | $43K | |
| 2021 | 1,055 | $38K | |
| 2023 | 646 | $16K | |
| 2024incomplete | 1,530 | $45K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 24% | 1,081 | 1,074 | $40K |
| D0272 | Bitewings - two radiographic images | 23% | 904 | 897 | $39K |
| D1120 | Dental cleaning, childProphylaxis - child | 13% | 1,270 | 1,263 | $22K |
| D2150 | Silver amalgam - two surfaces, primary or permanent | 12% | 209 | 81 | $20K |
| D1206 | Topical application of fluoride varnish | 11% | 1,378 | 1,374 | $19K |
| D0150 | Comprehensive oral evaluation - new or established patient | 6.1% | 221 | 221 | $10K |
| D0220 | Intraoral - periapical first radiographic image | 5.2% | 299 | 297 | $9K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 2.0% | 29 | 12 | $3K |
| D0274 | Bitewings - four radiographic images | 1.7% | 38 | 38 | $3K |
| D0230 | Intraoral - periapical each additional radiographic image | 1.2% | 172 | 168 | $2K |
| D1208 | Topical application of fluoride, excluding varnish | <1% | 19 | 15 | $20.48 |
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.