Based on public Medicaid payment data.
Jacob Orth Sisombath
Medicaid Provider in Dallas, TX
Type
Individual Provider
Address
2020 N Masters Dr
Dallas, TX 752173168
Phone
9722852600
NPI
1710154224
Procedures
3
Total Claims
26K
Patients Served
20.5K
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 | $45.73 | 15,210 | 15,156 |
| Dental Filling | $96.47 | 10,579 | 5,187 |
| Tooth Extraction | $29.58 | 196 | 111 |
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