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Provider 1457300329

NPI: 1457300329Share
Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$9.4M

$9,423,331

Total Claims

177K

Beneficiaries

121K

1.5 claims/patient

Avg Cost/Claim

$53

Monthly Spending Trend

Yearly Spending

2018
$1.3M
+1%
2019
$1.3M
-3%
2020
$1.2M
+33%
2021
$1.6M
+28%
2022
$2.1M
-50%
2023
$1.1M
-23%
2024
$819K

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 49% of total spending.

T1015Normal range

Clinic visit/encounter, all-inclusive

$4.6M

34K claims · 48.6%

Your Cost: $134.42/claim|Median: $121.16
1.1× median
D9450Top 25%

$1.3M

37K claims · 13.3%

Your Cost: $34.02/claim|Median: $21.95
1.5× median
D7210Normal range

Extraction, erupted tooth, surgical approach

$732K

8,478 claims · 7.8%

Your Cost: $86.33/claim|Median: $109.42
0.8× median
G0467Top 25%

Federally qualified health center visit, mental health

$468K

11K claims · 5.0%

Your Cost: $43.27/claim|Median: $21.91
2.0× median
T1040Normal range

Medicaid certified CCBHC services

$392K

2,833 claims · 4.2%

Your Cost: $138.29/claim|Median: $130.29
1.1× median
D1110Normal range

Prophylaxis, adult cleaning

$265K

8,172 claims · 2.8%

Your Cost: $32.37/claim|Median: $43.38
0.7× median
D0140Normal range

Limited oral evaluation, problem focused

$170K

7,354 claims · 1.8%

Your Cost: $23.16/claim|Median: $27.07
0.9× median
D2391Normal range

Resin-based composite, one surface, posterior

$116K

3,554 claims · 1.2%

Your Cost: $32.75/claim|Median: $54.60
0.6× median
D0210Normal range

Intraoral, complete series of radiographic images

$113K

2,796 claims · 1.2%

Your Cost: $40.47/claim|Median: $46.33
0.9× median
D2392Normal range

Resin-based composite, two surfaces, posterior

$104K

2,478 claims · 1.1%

Your Cost: $42.10/claim|Median: $71.00
0.6× median
D0274Normal range

Bitewings, four radiographic images

$102K

4,127 claims · 1.1%

Your Cost: $24.66/claim|Median: $22.54
1.1× median
D0120Normal range

Periodic oral evaluation, established patient

$95K

6,668 claims · 1.0%

Your Cost: $14.30/claim|Median: $24.34
0.6× median
D0330Normal range

Panoramic radiographic image

$95K

2,734 claims · 1.0%

Your Cost: $34.67/claim|Median: $37.36
0.9× median
99393Top 5%

Preventive medicine, established patient, age 5-11

$91K

660 claims · 1.0%

Your Cost: $137.72/claim|Median: $74.82
1.8× median
99394Top 10%

Preventive medicine, established patient, age 12-17

$85K

693 claims · 0.9%

Your Cost: $122.31/claim|Median: $80.15
1.5× median
D9110Normal range

$68K

2,655 claims · 0.7%

Your Cost: $25.58/claim|Median: $38.08
0.7× median
D0220Normal range

Intraoral periapical radiographic image, first film

$63K

6,792 claims · 0.7%

Your Cost: $9.21/claim|Median: $10.51
0.9× median
99395Top 5%

Preventive medicine, established patient, age 18-39

$45K

298 claims · 0.5%

Your Cost: $149.96/claim|Median: $72.71
2.1× median
D1120Top 10%

Prophylaxis, adult

$43K

865 claims · 0.5%

Your Cost: $49.98/claim|Median: $33.86
1.5× median
D1206Normal range

Topical application of fluoride varnish

$43K

1,813 claims · 0.5%

Your Cost: $23.83/claim|Median: $18.12
1.3× median
D7140Normal range

Extraction, erupted tooth or exposed root

$39K

975 claims · 0.4%

Your Cost: $39.99/claim|Median: $57.39
0.7× median
D0150Normal range

Comprehensive oral evaluation, new or established patient

$38K

1,745 claims · 0.4%

Your Cost: $21.86/claim|Median: $32.07
0.7× median
G2023Top 5%

Specimen collection for COVID-19 testing

$37K

923 claims · 0.4%

Your Cost: $40.26/claim|Median: $17.15
2.3× median
D2393Normal range

Resin-based composite, three surfaces, posterior

$29K

721 claims · 0.3%

Your Cost: $40.46/claim|Median: $84.26
0.5× median
D2331Normal range

Resin-based composite filling, two surfaces, anterior

$29K

618 claims · 0.3%

Your Cost: $46.90/claim|Median: $73.58
0.6× median
G0470Top 10%

Chronic care management services, FQHC/RHC

$27K

152 claims · 0.3%

Your Cost: $178.36/claim|Median: $45.95
3.9× median
90834Top 25%

Psychotherapy, 45 minutes

$26K

289 claims · 0.3%

Your Cost: $89.97/claim|Median: $63.65
1.4× median
D2330Normal range

Resin-based composite filling, one surface, anterior

$24K

700 claims · 0.3%

Your Cost: $34.99/claim|Median: $66.63
0.5× median
D1351Top 25%

Sealant, per tooth

$14K

390 claims · 0.1%

Your Cost: $36.06/claim|Median: $26.10
1.4× median
0011ANormal range

COVID-19 vaccine admin, Moderna, 1st dose

$14K

425 claims · 0.1%

Your Cost: $33.03/claim|Median: $25.93
1.3× median
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