Dental
Texas Super Smiles for Kids LLC
Texas Super Smiles for Kids LLC was paid $735K by Medicaid between Dec 2020 and Dec 2024, across 21 billing codes. Its largest line is D1120, dental cleaning, child — 12% of everything it billed.
33Billing provider infoTEXAS SUPER SMILES FOR KIDS LLC
PLAINVIEW, TX 79072
PLAINVIEW, TX 79072
33aNPI1023666328assigned 08/29/2019
33bProvider typePediatric Dentist
28Total paid$735K
24GClaims31,305
24DCodes billed21
24AFirst – last monthDec 2020 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Texas
Rank by total paid#227 of 693
Median peer was paid$252K
This provider vs. median2.9×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2020 | 49 | $676.20 | |
| 2021 | 764 | $10K | |
| 2022 | 8,119 | $192K | |
| 2023 | 9,763 | $247K | |
| 2024incomplete | 12,610 | $285K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 12% | 2,620 | 2,598 | $91K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 11% | 891 | 544 | $84K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 9.0% | 2,442 | 2,412 | $66K |
| D1351 | Sealant - per tooth | 8.5% | 2,380 | 465 | $63K |
| D0230 | Intraoral - periapical each additional radiographic image | 8.3% | 6,162 | 1,962 | $61K |
| D0145 | Oral evaluation for a patient under three years of age | 7.3% | 391 | 388 | $54K |
| D1206 | Topical application of fluoride varnish | 6.4% | 3,411 | 3,379 | $47K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 6.0% | 338 | 45 | $44K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 5.4% | 544 | 372 | $40K |
| D1110 | Prophylaxis - adult | 4.1% | 610 | 596 | $30K |
| D0220 | Intraoral - periapical first radiographic image | 3.4% | 2,376 | 2,339 | $25K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 3.3% | 936 | 898 | $24K |
9 more codes
| D0150 | Comprehensive oral evaluation - new or established patient | 3.1% | 716 | $23K |
| D0272 | Bitewings - two radiographic images | 3.0% | 1,246 | $22K |
| D0210 | Intraoral - complete series of radiographic images | 2.7% | 313 | $20K |
| D0274 | Bitewings - four radiographic images | 2.4% | 679 | $17K |
| D0330 | Panoramic radiographic image | 1.4% | 720 | $10K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 1.0% | 91 | $8K |
| D0140 | Limited oral evaluation - problem focused | <1% | 328 | $6K |
| D1354 | <1% | 42 | $409.48 | |
| D0603 | <1% | 4,069 | $0.01 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialMONTOYA, STEPHEN (OWNER)
| Provider | Location | Paid |
|---|---|---|
| Montoya Pediatric Dentistry LLC Dba San Tan Pediatric Dental | Queen Creek, AZ | $235K |
| Fiesta Kids Dental LLC | Mesa, AZ | $49K |
| Frankford Dental Group | Lubbock, TX | $19K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.