Based on public Medicaid payment data.
Wijaya Sulaeman
Medicaid Provider in San Bernardino, CA
Type
Individual Provider
Address
25054 Base Line St
San Bernardino, CA 924104026
Phone
9098899591
NPI
1932101706
Procedures
5
Total Claims
42.7K
Patients Served
37.7K
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 | $53.32 | 28,619 | 28,510 |
| Tooth Extraction | $81.21 | 7,490 | 4,592 |
| Dental Filling | $63.75 | 6,440 | 4,388 |
| Root Canal | $463.40 | 104 | 98 |
| Dental Crown | $469.46 | 91 | 66 |
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