Dental
Legacy Smiles of San Juan PLLC
Legacy Smiles of San Juan PLLC was paid $41K by Medicaid between Jul 2024 and Dec 2024, across 14 billing codes. Its largest line is D2391, Resin-based composite - one surface, posterior, primary or permanent — 36% of everything it billed.
33Billing provider infoLEGACY SMILES OF SAN JUAN PLLC
SAN JUAN, TX 78589
SAN JUAN, TX 78589
33aNPI1477320703assigned 12/06/2023
33bProvider typeGeneral Practice Dentistry
28Total paid$41K
24GClaims1,799
24DCodes billed14
24AFirst – last monthJul 2024 – Dec 2024
Compared with peers
Next to other General Practice Dentistry providers in Texas
Rank by total paid#1,403 of 2,774
Median peer was paid$43K
This provider vs. median1.0×
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 | |
|---|---|---|---|
| 2024incomplete | 1,799 | $41K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 36% | 227 | 60 | $15K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 17% | 78 | 27 | $7K |
| D0150 | Comprehensive oral evaluation - new or established patient | 12% | 154 | 150 | $5K |
| D0230 | Intraoral - periapical each additional radiographic image | 7.9% | 394 | 147 | $3K |
| D1120 | Dental cleaning, childProphylaxis - child | 5.9% | 77 | 75 | $2K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 5.0% | 81 | 74 | $2K |
| D1208 | Topical application of fluoride, excluding varnish | 3.5% | 110 | 107 | $1K |
| D1110 | Prophylaxis - adult | 3.3% | 28 | 28 | $1K |
| D0220 | Intraoral - periapical first radiographic image | 3.3% | 160 | 150 | $1K |
| D0210 | Intraoral - complete series of radiographic images | 2.2% | 13 | 13 | $918.32 |
| D0274 | Bitewings - four radiographic images | 2.2% | 36 | 36 | $889.48 |
| D0330 | Panoramic radiographic image | 1.9% | 91 | 88 | $791.97 |
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 officialJACOB, JERIN (DENTIST OWNER)