Based on public Medicaid payment data.
Lydia Koernianingsih
Medicaid Provider in Santa Ana, CA
Type
Individual Provider
Address
1125 E 17Th St Ste W234
Santa Ana, CA 927012228
Phone
7145584895
NPI
1083817423
Procedures
2
Total Claims
487
Patients Served
433
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 | $68.00 | 390 | 390 |
| Dental Filling | $65.81 | 97 | 43 |
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