Based on public Medicaid payment data.
Kusumo Sumardi
Medicaid Provider in La Verne, CA
Type
Individual Provider
Address
1965 Foothill Blvd
La Verne, CA 917503502
Phone
9095966500
NPI
1811037435
Procedures
4
Total Claims
2.9K
Patients Served
2.7K
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 | $60.33 | 2,290 | 2,290 |
| Dental Filling | $61.58 | 460 | 303 |
| Root Canal | $463.40 | 69 | 66 |
| Dental Crown | $476.00 | 46 | 40 |
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