Based on public Medicaid payment data.
David M. Ichimura
Medicaid Provider in San Jose, CA
Type
Individual Provider
Address
2400 Moorpark Ave Ste 110
San Jose, CA 951282623
Phone
4082861276
NPI
1417082041
Procedures
3
Total Claims
902
Patients Served
832
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 | $29.20 | 736 | 734 |
| Tooth Extraction | $45.92 | 130 | 71 |
| Dental Filling | $55.41 | 36 | 27 |
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