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Provider 1053337675

NPI: 1053337675Share
Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$12.7M

$12,731,527

Total Claims

796K

Beneficiaries

476K

1.7 claims/patient

Avg Cost/Claim

$16

Monthly Spending Trend

Yearly Spending

2018
$2.0M
-6%
2019
$1.8M
-16%
2020
$1.6M
+38%
2021
$2.2M
-1%
2022
$2.1M
-6%
2023
$2.0M
-48%
2024
$1.1M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (T1015 (Clinic visit/encounter, all-inclusive)) accounts for 60% of total spending.

T1015Normal range

Clinic visit/encounter, all-inclusive

$7.6M

98K claims · 59.9%

Your Cost: $77.89/claim|Median: $121.16
0.6× median
99213Normal range

Office/outpatient visit, est. patient, low-mod complexity

$1.2M

57K claims · 9.2%

Your Cost: $20.33/claim|Median: $37.81
0.5× median
90460Normal range

Immunization administration, first vaccine/toxoid, with counseling

$625K

51K claims · 4.9%

Your Cost: $12.26/claim|Median: $17.85
0.7× median
99392Normal range

Preventive medicine, established patient, age 1-4

$429K

15K claims · 3.4%

Your Cost: $29.57/claim|Median: $75.18
0.4× median
99214Normal range

Office/outpatient visit, est. patient, mod-high complexity

$385K

13K claims · 3.0%

Your Cost: $30.33/claim|Median: $53.41
0.6× median
99391Normal range

Preventive medicine, established patient, infant (under 1)

$291K

12K claims · 2.3%

Your Cost: $23.62/claim|Median: $69.35
0.3× median
99393Normal range

Preventive medicine, established patient, age 5-11

$286K

9,712 claims · 2.2%

Your Cost: $29.42/claim|Median: $74.82
0.4× median
D1120Normal range

Prophylaxis, adult

$259K

22K claims · 2.0%

Your Cost: $11.65/claim|Median: $33.86
0.3× median
D1206Normal range

Topical application of fluoride varnish

$218K

24K claims · 1.7%

Your Cost: $9.08/claim|Median: $18.12
0.5× median
D0120Normal range

Periodic oral evaluation, established patient

$214K

21K claims · 1.7%

Your Cost: $10.11/claim|Median: $24.34
0.4× median
99394Normal range

Preventive medicine, established patient, age 12-17

$152K

4,733 claims · 1.2%

Your Cost: $32.11/claim|Median: $80.15
0.4× median
90832Normal range

Psychotherapy, 30 minutes

$131K

6,504 claims · 1.0%

Your Cost: $20.09/claim|Median: $41.28
0.5× median
D0330Normal range

Panoramic radiographic image

$124K

4,794 claims · 1.0%

Your Cost: $25.81/claim|Median: $37.36
0.7× median
D0150Normal range

Comprehensive oral evaluation, new or established patient

$105K

6,890 claims · 0.8%

Your Cost: $15.21/claim|Median: $32.07
0.5× median
D1110Normal range

Prophylaxis, adult cleaning

$80K

4,021 claims · 0.6%

Your Cost: $19.81/claim|Median: $43.38
0.5× median
D0274Normal range

Bitewings, four radiographic images

$66K

7,314 claims · 0.5%

Your Cost: $9.05/claim|Median: $22.54
0.4× median
D0272Normal range

Bitewings, two radiographic images

$56K

11K claims · 0.4%

Your Cost: $5.27/claim|Median: $15.81
0.3× median
92551Normal range

Screening audiometry, pure tone, air only

$48K

15K claims · 0.4%

Your Cost: $3.20/claim|Median: $6.61
0.5× median
D2140Normal range

Amalgam, one surface, primary or permanent

$44K

2,341 claims · 0.3%

Your Cost: $18.71/claim|Median: $52.77
0.4× median
D2150Normal range

Amalgam, two surfaces, primary or permanent

$40K

1,663 claims · 0.3%

Your Cost: $24.24/claim|Median: $66.00
0.4× median
99381Normal range

Preventive visit, new patient, infant (<1 yr)

$39K

2,194 claims · 0.3%

Your Cost: $17.69/claim|Median: $73.46
0.2× median
D2391Normal range

Resin-based composite, one surface, posterior

$38K

1,537 claims · 0.3%

Your Cost: $24.42/claim|Median: $54.60
0.4× median
D1354Normal range

$35K

3,566 claims · 0.3%

Your Cost: $9.81/claim|Median: $12.52
0.8× median
D1351Normal range

Sealant, per tooth

$31K

2,131 claims · 0.2%

Your Cost: $14.77/claim|Median: $26.10
0.6× median
99212Normal range

Office/outpatient visit, low complexity

$23K

1,942 claims · 0.2%

Your Cost: $11.62/claim|Median: $25.06
0.5× median
0012ANormal range

COVID-19 vaccine admin, Moderna, 2nd dose

$17K

973 claims · 0.1%

Your Cost: $17.86/claim|Median: $33.85
0.5× median
G0467Normal range

Federally qualified health center visit, mental health

$16K

1,488 claims · 0.1%

Your Cost: $10.85/claim|Median: $21.91
0.5× median
0011ANormal range

COVID-19 vaccine admin, Moderna, 1st dose

$14K

881 claims · 0.1%

Your Cost: $16.16/claim|Median: $25.93
0.6× median
0002ANormal range

COVID-19 vaccine admin, Pfizer, 2nd dose

$13K

645 claims · 0.1%

Your Cost: $20.65/claim|Median: $36.70
0.6× median
0001ANormal range

COVID-19 vaccine admin, Pfizer, 1st dose

$13K

604 claims · 0.1%

Your Cost: $21.14/claim|Median: $33.72
0.6× median
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