Dental
Pristine Smile Dental PLLC
Pristine Smile Dental PLLC was paid $16K by Medicaid between Oct 2023 and Dec 2024, across 7 billing codes. Its largest line is D1120, dental cleaning, child — 49% of everything it billed.
33Billing provider infoPRISTINE SMILE DENTAL PLLC
MANCHESTER, CT 06040
MANCHESTER, CT 06040
33aNPI1316692106assigned 02/20/2022
33bProvider typeGeneral Practice Dentistry
28Total paid$16K
24GClaims454
24DCodes billed7
24AFirst – last monthOct 2023 – Dec 2024
Compared with peers
Next to other General Practice Dentistry providers in Connecticut
Rank by total paid#290 of 431
Median peer was paid$79K
This provider vs. median0.2×
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 | |
|---|---|---|---|
| 2023 | 135 | $4K | |
| 2024incomplete | 319 | $12K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 49% | 188 | 177 | $8K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 16% | 97 | 87 | $3K |
| D0150 | Comprehensive oral evaluation - new or established patient | 15% | 45 | 42 | $2K |
| D1206 | Topical application of fluoride varnish | 8.5% | 49 | 48 | $1K |
| D0274 | Bitewings - four radiographic images | 5.5% | 25 | 24 | $876.96 |
| D1208 | Topical application of fluoride, excluding varnish | 4.7% | 37 | 29 | $738.92 |
| D1110 | Prophylaxis - adult | 1.0% | 13 | 12 | $166.40 |
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 officialHERNANDEZ, JASON (DENTIST OWNER)
| Provider | Location | Paid |
|---|---|---|
| City of Waterloo | Waterloo, IA | $15.32M |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.