Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

⚖️ Compare🖨️ Print Report

Provider 1316040249

NPI: 1316040249Share
Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$8.0M

$8,044,625

Total Claims

31K

Beneficiaries

21K

1.5 claims/patient

Avg Cost/Claim

$257

Monthly Spending Trend

Yearly Spending

2018
$966K
+46%
2019
$1.4M
-14%
2020
$1.2M
-14%
2021
$1.0M
+64%
2022
$1.7M
-42%
2023
$984K
-24%
2024
$747K

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (99213 (Office/outpatient visit, est. patient, low-mod complexity)) accounts for 27% of total spending.

99213Top 1%

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

$2.2M

7,845 claims · 27.0%

Your Cost: $276.79/claim|Median: $37.81
7.3× median
99214Top 1%

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

$1.7M

5,848 claims · 21.0%

Your Cost: $288.76/claim|Median: $53.41
5.4× median
H0004Top 5%

Behavioral health counseling & therapy, per 15 min

$592K

2,157 claims · 7.4%

Your Cost: $274.23/claim|Median: $74.63
3.7× median
H0005Top 1%

Alcohol and/or drug services, group counseling

$556K

2,560 claims · 6.9%

Your Cost: $217.32/claim|Median: $47.35
4.6× median
90853Top 5%

Group psychotherapy

$525K

2,439 claims · 6.5%

Your Cost: $215.28/claim|Median: $25.02
8.6× median
H0006Top 1%

Alcohol and/or drug services, case management

$373K

1,512 claims · 4.6%

Your Cost: $246.53/claim|Median: $43.10
5.7× median
98968Top 5%

$223K

872 claims · 2.8%

Your Cost: $256.26/claim|Median: $28.39
9.0× median
D0140Top 1%

Limited oral evaluation, problem focused

$210K

491 claims · 2.6%

Your Cost: $426.72/claim|Median: $27.07
15.8× median
D0150Top 1%

Comprehensive oral evaluation, new or established patient

$207K

375 claims · 2.6%

Your Cost: $552.57/claim|Median: $32.07
17.2× median
90832Top 5%

Psychotherapy, 30 minutes

$195K

889 claims · 2.4%

Your Cost: $219.49/claim|Median: $41.28
5.3× median
98967Top 1%

$194K

696 claims · 2.4%

Your Cost: $279.31/claim|Median: $18.97
14.7× median
90471Top 1%

Immunization administration, 1 vaccine, percutaneous/ID/SC/IM

$147K

843 claims · 1.8%

Your Cost: $174.48/claim|Median: $9.80
17.8× median
H0032Top 5%

Mental health service plan development

$137K

466 claims · 1.7%

Your Cost: $294.26/claim|Median: $80.64
3.6× median
99212Top 1%

Office/outpatient visit, low complexity

$136K

357 claims · 1.7%

Your Cost: $381.09/claim|Median: $25.06
15.2× median
D0120Top 1%

Periodic oral evaluation, established patient

$120K

335 claims · 1.5%

Your Cost: $358.48/claim|Median: $24.34
14.7× median
D1120Top 1%

Prophylaxis, adult

$98K

305 claims · 1.2%

Your Cost: $321.00/claim|Median: $33.86
9.5× median
90834Top 1%

Psychotherapy, 45 minutes

$86K

314 claims · 1.1%

Your Cost: $274.41/claim|Median: $63.65
4.3× median
90837Top 5%

Psychotherapy, 60 minutes

$73K

286 claims · 0.9%

Your Cost: $254.96/claim|Median: $85.66
3.0× median
H0048Top 1%

$70K

472 claims · 0.9%

Your Cost: $147.70/claim|Median: $13.25
11.1× median
99211Top 1%

Office/outpatient visit, minimal complexity

$60K

157 claims · 0.7%

Your Cost: $382.14/claim|Median: $12.93
29.6× median
87635Normal range

COVID-19 SARS-CoV-2 amplified probe detection

$32K

719 claims · 0.4%

Your Cost: $43.87/claim|Median: $39.70
1.1× median
98966Top 1%

$28K

89 claims · 0.4%

Your Cost: $319.50/claim|Median: $6.84
46.7× median
92014Top 1%

Ophthalmological exam, comprehensive, established patient

$22K

51 claims · 0.3%

Your Cost: $435.70/claim|Median: $47.08
9.3× median
D1110Top 1%

Prophylaxis, adult cleaning

$21K

53 claims · 0.3%

Your Cost: $405.14/claim|Median: $43.38
9.3× median
92004Top 1%

Ophthalmological exam, comprehensive, new patient

$16K

39 claims · 0.2%

Your Cost: $411.30/claim|Median: $59.72
6.9× median
D1354Top 1%

$10K

14 claims · 0.1%

Your Cost: $719.00/claim|Median: $12.52
57.4× median
H0038Top 10%

Self-help/peer services, per 15 minutes

$8K

27 claims · 0.1%

Your Cost: $297.20/claim|Median: $55.04
5.4× median
99215Top 5%

Office/outpatient visit, high complexity

$8K

31 claims · 0.1%

Your Cost: $244.69/claim|Median: $74.09
3.3× median
G0659Normal range

$7K

213 claims · 0.1%

Your Cost: $32.17/claim|Median: $32.24
1.0× median
D2392Top 1%

Resin-based composite, two surfaces, posterior

$6K

16 claims · 0.1%

Your Cost: $404.50/claim|Median: $71.00
5.7× median
← All providersHow we detect fraud →