SMILE LOFT NORTH POTOMAC LLC

NPI: 1093420713 · NORTH POTOMAC, MD 20878 · General Practice Dentistry · NPI assigned 01/17/2023

$36K

Total Medicaid Paid

682

Total Claims

627

Beneficiaries

Codes Billed

2023-05

First Month

2024-11

Last Month

Provider Details

Authorized Official	RAI, VAIBHAV (MEMBER)
NPI Enumeration Date	01/17/2023

Other providers sharing the same authorized official: RAI, VAIBHAV

Provider	City	State	Total Paid
SMILE LOFT LANDOVER DENTAL LLC	LANDOVER HILLS	MD	$1.14M
VAIBHAV RAI DDS LLC	LAUREL	MD	$701K
SMILE LOFT TOWNE CENTER LLC	LAUREL	MD	$249K
SMILE LOFT AFFINITY DENTAL LLC	CATONSVILLE	MD	$218K
SMILE LOFT MIDDLE RIVER LLC	MIDDLE RIVER	MD	$597.35
SMILE LOFT BETHESDA LLC	BETHESDA	MD	$323.96

Year	Claims	Total Paid
2023	98	$4K
2024	584	$31K

Code	Description	Claims	Beneficiaries	Total Paid
D0150	Comprehensive oral evaluation - new or established patient	180	180	$10K
D2750		17	13	$7K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	51	25	$7K
D1110	Prophylaxis - adult	48	48	$3K
D0220	Intraoral - periapical first radiographic image	184	161	$2K
D0330	Panoramic radiographic image	40	40	$2K
D0230	Intraoral - periapical each additional radiographic image	67	66	$1K
D0274	Bitewings - four radiographic images	42	42	$1K
D0120	Periodic oral evaluation - established patient	28	28	$888.87
D0210	Intraoral - complete series of radiographic images	13	12	$684.00
D1206	Topical application of fluoride varnish	12	12	$301.78