Mitsumoto, Rossarin

Mitsumoto, Rossarin was paid $8.30M by Medicaid between Jan 2018 and Dec 2024, across 36 billing codes. Its largest line is D1120, dental cleaning, child — 13% of everything it billed.

33Billing provider infoMITSUMOTO, ROSSARIN
SLEEPY HOLLOW, NY 10591

33aNPI1922238450assigned 07/17/2009

33bProvider typePediatric Dentist

28Total paid$8.30M

24GClaims289,815

24DCodes billed36

24AFirst – last monthJan 2018 – Dec 2024

Compared with peers

Next to other Pediatric Dentist providers in New York

Rank by total paid#12 of 514

Median peer was paid$196K

This provider vs. median42×

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	17,320	$499K
2019	28,467	$817K
2020	30,237	$847K
2021	40,382	$1.21M
2022	49,970	$1.46M
2023	62,590	$1.83M
2024incomplete	60,849	$1.64M

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1120	Dental cleaning, childProphylaxis - child	13%	34,013	33,980	$1.11M
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	10%	14,818	7,550	$843K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	10.0%	36,104	36,065	$827K
D1351	Sealant - per tooth	8.5%	19,258	5,997	$706K
D2391	Resin-based composite - one surface, posterior, primary or permanent	7.6%	15,552	7,560	$634K
D2930	Prefabricated stainless steel crown - primary tooth	7.5%	6,319	2,828	$623K
D0274	Bitewings - four radiographic images	7.5%	26,270	26,238	$618K
D1208	Topical application of fluoride, excluding varnish	5.6%	41,502	41,461	$464K
D2335		4.8%	3,495	1,255	$398K
D1110	Prophylaxis - adult	4.2%	8,303	8,295	$350K
D7140	Extraction, erupted tooth or exposed root	4.1%	6,923	4,451	$342K
D0220	Intraoral - periapical first radiographic image	3.8%	29,160	28,965	$316K

24 more codes

D1354		3.0%	7,447	$252K
D0150	Comprehensive oral evaluation - new or established patient	1.9%	6,823	$157K
D1206	Topical application of fluoride varnish	1.4%	4,481	$119K
D2393	Resin-based composite - three surfaces, posterior, primary or permanent	1.2%	1,357	$97K
D0140	Limited oral evaluation - problem focused	<1%	6,525	$79K
D0272	Bitewings - two radiographic images	<1%	4,694	$65K
D0230	Intraoral - periapical each additional radiographic image	<1%	10,249	$62K
D0330	Panoramic radiographic image	<1%	2,353	$60K
D2330		<1%	1,264	$53K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	<1%	1,052	$39K
D2331		<1%	365	$25K
D3220	Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction	<1%	184	$13K
D2332		<1%	155	$12K
D0145	Oral evaluation for a patient under three years of age	<1%	469	$11K
D2150	Silver amalgam - two surfaces, primary or permanent	<1%	85	$6K
D0210	Intraoral - complete series of radiographic images	<1%	338	$5K
D2140		<1%	95	$4K
D2920		<1%	25	$905.88
D9310		<1%	13	$687.97
D7111		<1%	19	$578.54
D9110		<1%	31	$344.32
D0270		<1%	13	$160.55
D9997		<1%	27	$60.00
D1330		0%	34	$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.