Dental
South Shore Smiles LLC
South Shore Smiles LLC was paid $3.77M by Medicaid between Jan 2018 and Dec 2024, across 28 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 14% of everything it billed.
33Billing provider infoSOUTH SHORE SMILES LLC
SAINT JOHN, IN 46373
SAINT JOHN, IN 46373
33aNPI1356898050assigned 09/09/2016
33bProvider typePediatric Dentist
28Total paid$3.77M
24GClaims100,895
24DCodes billed28
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Indiana
Rank by total paid#12 of 155
Median peer was paid$414K
This provider vs. median9.1×
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 | 6,441 | $37K | |
| 2019 | 11,619 | $437K | |
| 2020 | 10,764 | $361K | |
| 2021 | 14,824 | $553K | |
| 2022 | 23,162 | $1.01M | |
| 2023 | 22,202 | $901K | |
| 2024incomplete | 11,883 | $477K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 14% | 3,830 | 1,239 | $532K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 9.1% | 5,521 | 3,155 | $344K |
| D1351 | Sealant - per tooth | 7.9% | 11,180 | 2,664 | $298K |
| D1120 | Dental cleaning, childProphylaxis - child | 7.9% | 9,824 | 9,398 | $298K |
| D1110 | Prophylaxis - adult | 7.0% | 5,280 | 5,088 | $263K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 6.9% | 11,370 | 10,967 | $259K |
| D7140 | Extraction, erupted tooth or exposed root | 6.2% | 3,263 | 1,470 | $235K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 6.0% | 2,432 | 811 | $224K |
| D1206 | Topical application of fluoride varnish | 4.3% | 7,461 | 7,259 | $163K |
| D0150 | Comprehensive oral evaluation - new or established patient | 3.5% | 4,111 | 3,919 | $131K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 3.4% | 4,701 | 4,330 | $128K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 3.3% | 1,660 | 1,188 | $123K |
16 more codes
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 3.1% | 2,381 | $118K |
| D0272 | Bitewings - two radiographic images | 2.6% | 4,338 | $99K |
| D0330 | Panoramic radiographic image | 2.0% | 1,524 | $77K |
| D0210 | Intraoral - complete series of radiographic images | 2.0% | 2,612 | $75K |
| D0274 | Bitewings - four radiographic images | 2.0% | 2,026 | $74K |
| D1510 | 1.9% | 420 | $72K | |
| D0230 | Intraoral - periapical each additional radiographic image | 1.8% | 7,791 | $69K |
| D1208 | Topical application of fluoride, excluding varnish | 1.6% | 3,484 | $59K |
| D0220 | Intraoral - periapical first radiographic image | 1.1% | 3,907 | $41K |
| D2330 | <1% | 410 | $29K | |
| D0140 | Limited oral evaluation - problem focused | <1% | 913 | $29K |
| D2332 | <1% | 162 | $17K | |
| D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | <1% | 60 | $9K |
| D1354 | <1% | 48 | $5K | |
| D0240 | <1% | 170 | $518.00 | |
| D9920 | <1% | 16 | $46.75 |
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 officialSHIEH, ROGER (OWNER)