Grand Smile Dental

Grand Smile Dental was paid $47K by Medicaid between Jan 2018 and Dec 2019, across 9 billing codes. Its largest line is D1110, Prophylaxis - adult — 31% of everything it billed.

33Billing provider infoGRAND SMILE DENTAL
MASPETH, NY 11378

33aNPI1467706689assigned 11/09/2012

33bProvider typeDentist

28Total paid$47K

24GClaims2,144

24DCodes billed9

24AFirst – last monthJan 2018 – Dec 2019

Compared with peers

Next to other Dentist providers in New York

Rank by total paid#844 of 1,649

Median peer was paid$49K

This provider vs. median0.9×

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
2018	866	$21K
2019	1,278	$26K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1110	Prophylaxis - adult	31%	335	334	$15K
D0210	Intraoral - complete series of radiographic images	21%	468	462	$10K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	20%	442	440	$9K
D0230	Intraoral - periapical each additional radiographic image	12%	354	354	$5K
D0220	Intraoral - periapical first radiographic image	9.1%	398	395	$4K
D1208	Topical application of fluoride, excluding varnish	2.5%	107	107	$1K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	2.4%	15	12	$1K
D1120	Dental cleaning, childProphylaxis - child	<1%	12	12	$363.24
D0274	Bitewings - four radiographic images	<1%	13	13	$301.60

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 officialKHAIMOV, ALEXANDRA (DENTIST)