Godbolt, Emerson

Godbolt, Emerson was paid $30K by Medicaid between Apr 2021 and Jan 2022, across 12 billing codes. Its largest line is D0274, Bitewings - four radiographic images — 33% of everything it billed.

33Billing provider infoGODBOLT, EMERSON
SANDPOINT, ID 83864

33aNPI1902211725assigned 07/01/2014

33bProvider typeGeneral Practice Dentistry

28Total paid$30K

24GClaims1,911

24DCodes billed12

24AFirst – last monthApr 2021 – Jan 2022

Compared with peers

Next to other General Practice Dentistry providers in Idaho

Rank by total paid#82 of 173

Median peer was paid$22K

This provider vs. median1.3×

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
2021	1,727	$27K
2022	184	$3K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D0274	Bitewings - four radiographic images	33%	183	183	$10K
D1110	Prophylaxis - adult	30%	242	242	$9K
D0210	Intraoral - complete series of radiographic images	15%	61	61	$4K
D1120	Dental cleaning, childProphylaxis - child	12%	43	43	$3K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	6.3%	64	39	$2K
D0140	Limited oral evaluation - problem focused	2.8%	42	41	$843.69
D0330	Panoramic radiographic image	<1%	36	36	$182.59
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	<1%	301	301	$109.58
D0220	Intraoral - periapical first radiographic image	0%	314	313	$0.00
D0230	Intraoral - periapical each additional radiographic image	0%	313	236	$0.00
D1208	Topical application of fluoride, excluding varnish	0%	239	239	$0.00
D0150	Comprehensive oral evaluation - new or established patient	0%	73	73	$0.00

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.