DENTAL SMILES FOR KIDS, LLC

NPI: 1487396859 · CENTEREACH, NY 11720 · Pediatric Dentist · NPI assigned 04/07/2022

$79K

Total Medicaid Paid

2,910

Total Claims

2,899

Beneficiaries

Codes Billed

2022-05

First Month

2023-12

Last Month

Provider Details

Authorized Official	KOURTSOUNIS, PARASKEVAS (OWNER)
NPI Enumeration Date	04/07/2022

Other providers sharing the same authorized official: KOURTSOUNIS, PARASKEVAS

Provider	City	State	Total Paid
SUPERSMILES KDS DENTAL PC	RIVERHEAD	NY	$5.88M
DENTAL SMILES FOR KIDS, LLC	ASTORIA	NY	$604K
DENTAL SMILES FOR KIDS, LLC	NORTH BABYLON	NY	$181K
DENTAL SMILES FOR KIDS, LLC	RONKONKOMA	NY	$150K
DENTAL SMILES FOR KIDS	LEVITTOWN	NY	$65K
DENTAL SMILES FOR KIDS, LLC	LEVITTOWN	NY	$348.00

Year	Claims	Total Paid
2022	919	$24K
2023	1,991	$55K

Code	Description	Claims	Beneficiaries	Total Paid
D1120	Prophylaxis - child	711	711	$31K
D0120	Periodic oral evaluation - established patient	663	663	$19K
D1208	Topical application of fluoride, excluding varnish	596	596	$8K
D0272	Bitewings - two radiographic images	409	409	$7K
D1206	Topical application of fluoride varnish	161	161	$5K
D0220	Intraoral - periapical first radiographic image	250	248	$3K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	24	15	$3K
D0150	Comprehensive oral evaluation - new or established patient	82	82	$2K
D1110	Prophylaxis - adult	14	14	$812.00