Based on public Medicaid payment data.
Lita Hermansjah
Medicaid Provider in Corona, CA
Type
Individual Provider
Address
916 West Sixth Street
Corona, CA 928823239
Phone
9517381749
NPI
1740367440
Procedures
2
Total Claims
3.3K
Patients Served
3.1K
About these costs
All amounts reflect Medicaid reimbursement rates, which are typically much lower than private insurance or cash prices. These figures show what state Medicaid programs actually paid this provider per claim.
Procedures & Average Costs
| Procedure | Avg. Paid | Claims | Patients |
|---|---|---|---|
| Dental Cleaning & Exam | $56.01 | 3,035 | 3,013 |
| Dental Filling | $66.89 | 244 | 129 |
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