Clinic
Summit City Smiles
Summit City Smiles was paid $114K by Medicaid between Mar 2018 and Jul 2024, across 9 billing codes. Its largest line is D1110, Prophylaxis - adult — 36% of everything it billed.
33Billing provider infoSUMMIT CITY SMILES
FORT WAYNE, IN 46805
FORT WAYNE, IN 46805
33aNPI1083080386assigned 08/20/2015
33bProvider typeDental Clinic/Center
28Total paid$114K
24GClaims4,455
24DCodes billed9
24AFirst – last monthMar 2018 – Jul 2024
Compared with peers
Next to other Dental Clinic/Center providers in Indiana
Rank by total paid#72 of 123
Median peer was paid$191K
This provider vs. median0.6×
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 | |
|---|---|---|---|
| 2018 | 122 | $943.31 | |
| 2019 | 396 | $10K | |
| 2020 | 1,001 | $22K | |
| 2021 | 1,396 | $41K | |
| 2022 | 881 | $23K | |
| 2023 | 494 | $12K | |
| 2024incomplete | 165 | $6K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 36% | 875 | 827 | $41K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 25% | 1,306 | 1,230 | $28K |
| D1206 | Topical application of fluoride varnish | 15% | 1,255 | 1,166 | $17K |
| D1120 | Dental cleaning, childProphylaxis - child | 7.8% | 289 | 271 | $9K |
| D0150 | Comprehensive oral evaluation - new or established patient | 5.8% | 178 | 163 | $7K |
| D0210 | Intraoral - complete series of radiographic images | 5.3% | 116 | 99 | $6K |
| D0274 | Bitewings - four radiographic images | 3.9% | 122 | 118 | $4K |
| D0140 | Limited oral evaluation - problem focused | 1.3% | 43 | 38 | $1K |
| D1999 | <1% | 271 | 208 | $160.00 |
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 officialVALLIERE, ROGER (PRESIDENT)