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Provider 1629040621

NPI: 1629040621Share
Active Billing Period:2018-01→2024-12(74 months)

Total Paid

$11.7M

$11,730,051

Total Claims

149K

Beneficiaries

108K

1.4 claims/patient

Avg Cost/Claim

$79

Monthly Spending Trend

Yearly Spending

2018
$87K
-89%
2019
$10K
+4827%
2020
$478K
+535%
2021
$3.0M
-1%
2022
$3.0M
-8%
2023
$2.8M
-15%
2024
$2.3M

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 79% of total spending.

T1015Normal range

Clinic visit/encounter, all-inclusive

$9.2M

57K claims · 78.5%

Your Cost: $160.89/claim|Median: $121.16
1.3× median
D0999Top 25%

Unspecified diagnostic procedure, by report

$889K

4,468 claims · 7.6%

Your Cost: $198.91/claim|Median: $101.33
2.0× median
99213Normal range

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

$718K

30K claims · 6.1%

Your Cost: $23.65/claim|Median: $37.81
0.6× median
99214Normal range

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

$226K

7,605 claims · 1.9%

Your Cost: $29.72/claim|Median: $53.41
0.6× median
99394Normal range

Preventive medicine, established patient, age 12-17

$209K

5,050 claims · 1.8%

Your Cost: $41.41/claim|Median: $80.15
0.5× median
99212Normal range

Office/outpatient visit, low complexity

$156K

8,749 claims · 1.3%

Your Cost: $17.81/claim|Median: $25.06
0.7× median
99393Normal range

Preventive medicine, established patient, age 5-11

$136K

3,433 claims · 1.2%

Your Cost: $39.63/claim|Median: $74.82
0.5× median
99392Normal range

Preventive medicine, established patient, age 1-4

$71K

2,137 claims · 0.6%

Your Cost: $33.03/claim|Median: $75.18
0.4× median
G0467Normal range

Federally qualified health center visit, mental health

$70K

2,523 claims · 0.6%

Your Cost: $27.88/claim|Median: $21.91
1.3× median
0001ANormal range

COVID-19 vaccine admin, Pfizer, 1st dose

$5K

242 claims · 0.0%

Your Cost: $20.66/claim|Median: $33.72
0.6× median
0012ANormal range

COVID-19 vaccine admin, Moderna, 2nd dose

$5K

596 claims · 0.0%

Your Cost: $7.99/claim|Median: $33.85
0.2× median
99391Normal range

Preventive medicine, established patient, infant (under 1)

$5K

268 claims · 0.0%

Your Cost: $17.48/claim|Median: $69.35
0.3× median
0002ANormal range

COVID-19 vaccine admin, Pfizer, 2nd dose

$5K

202 claims · 0.0%

Your Cost: $22.97/claim|Median: $36.70
0.6× median
G0402Normal range

Initial preventive physical exam (Welcome to Medicare)

$4K

234 claims · 0.0%

Your Cost: $17.74/claim|Median: $22.62
0.8× median
90686Normal range

Influenza virus vaccine, quadrivalent, preservative-free, IM

$4K

3,359 claims · 0.0%

Your Cost: $1.14/claim|Median: $7.18
0.2× median
0011ANormal range

COVID-19 vaccine admin, Moderna, 1st dose

$3K

672 claims · 0.0%

Your Cost: $4.56/claim|Median: $25.93
0.2× median
0072ANormal range

$3K

111 claims · 0.0%

Your Cost: $23.06/claim|Median: $39.57
0.6× median
0031ANormal range

COVID-19 vaccine admin, J&J, single dose

$2K

137 claims · 0.0%

Your Cost: $12.23/claim|Median: $32.49
0.4× median
U0004Normal range

COVID-19 test, nucleic acid detection, CDC lab only

$1K

203 claims · 0.0%

Your Cost: $7.02/claim|Median: $60.05
0.1× median
99211Normal range

Office/outpatient visit, minimal complexity

$1K

699 claims · 0.0%

Your Cost: $1.71/claim|Median: $12.93
0.1× median
0071ANormal range

$1K

43 claims · 0.0%

Your Cost: $26.05/claim|Median: $38.71
0.7× median
90621Normal range

$1K

556 claims · 0.0%

Your Cost: $1.98/claim|Median: $7.66
0.3× median
90460Normal range

Immunization administration, first vaccine/toxoid, with counseling

$821

362 claims · 0.0%

Your Cost: $2.27/claim|Median: $17.85
0.1× median
90651Normal range

HPV vaccine, 9-valent

$757

747 claims · 0.0%

Your Cost: $1.01/claim|Median: $8.93
0.1× median
96110Normal range

Developmental screening, per standardized instrument

$464

181 claims · 0.0%

Your Cost: $2.56/claim|Median: $9.10
0.3× median
D0120Normal range

Periodic oral evaluation, established patient

$141

1,926 claims · 0.0%

Your Cost: $0.07/claim|Median: $24.34
0.0× median
D1110Normal range

Prophylaxis, adult cleaning

$110

592 claims · 0.0%

Your Cost: $0.19/claim|Median: $43.38
0.0× median
D0272Normal range

Bitewings, two radiographic images

$94

1,545 claims · 0.0%

Your Cost: $0.06/claim|Median: $15.81
0.0× median
D1208Normal range

Topical application of fluoride, excluding varnish

$88

1,852 claims · 0.0%

Your Cost: $0.05/claim|Median: $14.36
0.0× median
D1351Normal range

Sealant, per tooth

$85

2,459 claims · 0.0%

Your Cost: $0.03/claim|Median: $26.10
0.0× median
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