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Provider 1710979588

NPI: 1710979588Share
Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$10.3M

$10,254,047

Total Claims

261K

Beneficiaries

212K

1.2 claims/patient

Avg Cost/Claim

$39

Monthly Spending Trend

Yearly Spending

2018
$1.0M
+36%
2019
$1.4M
-21%
2020
$1.1M
+31%
2021
$1.5M
-1%
2022
$1.4M
+23%
2023
$1.8M
+14%
2024
$2.0M

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 74% of total spending.

T1015Normal range

Clinic visit/encounter, all-inclusive

$7.6M

66K claims · 73.9%

Your Cost: $115.12/claim|Median: $121.16
1.0× median
D0999Normal range

Unspecified diagnostic procedure, by report

$2.4M

27K claims · 23.7%

Your Cost: $90.39/claim|Median: $101.33
0.9× median
D0120Normal range

Periodic oral evaluation, established patient

$55K

7,524 claims · 0.5%

Your Cost: $7.37/claim|Median: $24.34
0.3× median
D7140Normal range

Extraction, erupted tooth or exposed root

$27K

7,492 claims · 0.3%

Your Cost: $3.54/claim|Median: $57.39
0.1× median
T1040Normal range

Medicaid certified CCBHC services

$23K

347 claims · 0.2%

Your Cost: $67.43/claim|Median: $130.29
0.5× median
D0140Normal range

Limited oral evaluation, problem focused

$23K

3,650 claims · 0.2%

Your Cost: $6.36/claim|Median: $27.07
0.2× median
D0272Normal range

Bitewings, two radiographic images

$22K

3,486 claims · 0.2%

Your Cost: $6.35/claim|Median: $15.81
0.4× median
D1120Normal range

Prophylaxis, adult

$20K

1,715 claims · 0.2%

Your Cost: $11.68/claim|Median: $33.86
0.3× median
99213Normal range

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

$19K

34K claims · 0.2%

Your Cost: $0.55/claim|Median: $37.81
0.0× median
D2392Normal range

Resin-based composite, two surfaces, posterior

$13K

898 claims · 0.1%

Your Cost: $14.27/claim|Median: $71.00
0.2× median
D2391Normal range

Resin-based composite, one surface, posterior

$13K

1,196 claims · 0.1%

Your Cost: $10.50/claim|Median: $54.60
0.2× median
D0220Normal range

Intraoral periapical radiographic image, first film

$10K

2,284 claims · 0.1%

Your Cost: $4.47/claim|Median: $10.51
0.4× median
D0330Normal range

Panoramic radiographic image

$7K

3,200 claims · 0.1%

Your Cost: $2.18/claim|Median: $37.36
0.1× median
99212Normal range

Office/outpatient visit, low complexity

$5K

13K claims · 0.1%

Your Cost: $0.43/claim|Median: $25.06
0.0× median
99214Normal range

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

$5K

2,522 claims · 0.1%

Your Cost: $2.13/claim|Median: $53.41
0.0× median
D2330Normal range

Resin-based composite filling, one surface, anterior

$2K

278 claims · 0.0%

Your Cost: $8.70/claim|Median: $66.63
0.1× median
D1110Normal range

Prophylaxis, adult cleaning

$2K

331 claims · 0.0%

Your Cost: $6.48/claim|Median: $43.38
0.1× median
D2393Normal range

Resin-based composite, three surfaces, posterior

$1K

26 claims · 0.0%

Your Cost: $38.67/claim|Median: $84.26
0.5× median
0502FNormal range

$963

371 claims · 0.0%

Your Cost: $2.60/claim|Median: $44.10
0.1× median
99203Normal range

Office/outpatient visit, new patient, low-mod complexity

$793

1,035 claims · 0.0%

Your Cost: $0.77/claim|Median: $57.85
0.0× median
90834Normal range

Psychotherapy, 45 minutes

$707

858 claims · 0.0%

Your Cost: $0.82/claim|Median: $63.65
0.0× median
0012ANormal range

COVID-19 vaccine admin, Moderna, 2nd dose

$553

19 claims · 0.0%

Your Cost: $29.11/claim|Median: $33.85
0.9× median
99394Normal range

Preventive medicine, established patient, age 12-17

$442

806 claims · 0.0%

Your Cost: $0.55/claim|Median: $80.15
0.0× median
87880Normal range

Streptococcus, Group A, rapid antigen detection

$392

853 claims · 0.0%

Your Cost: $0.46/claim|Median: $11.48
0.0× median
81002Normal range

Urinalysis, non-automated without microscopy

$383

2,256 claims · 0.0%

Your Cost: $0.17/claim|Median: $2.00
0.1× median
0011ANormal range

COVID-19 vaccine admin, Moderna, 1st dose

$288

17 claims · 0.0%

Your Cost: $16.94/claim|Median: $25.93
0.7× median
99393Normal range

Preventive medicine, established patient, age 5-11

$253

602 claims · 0.0%

Your Cost: $0.42/claim|Median: $74.82
0.0× median
90688Normal range

$177

543 claims · 0.0%

Your Cost: $0.33/claim|Median: $9.00
0.0× median
D1206Normal range

Topical application of fluoride varnish

$113

1,637 claims · 0.0%

Your Cost: $0.07/claim|Median: $18.12
0.0× median
81025Normal range

Urine pregnancy test

$82

1,126 claims · 0.0%

Your Cost: $0.07/claim|Median: $4.81
0.0× median
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