Clinic
Custom Smiles Dentistry, PLLC
Custom Smiles Dentistry, PLLC was paid $335K by Medicaid between Oct 2020 and Dec 2024, across 14 billing codes. Its largest line is D1206, Topical application of fluoride varnish — 12% of everything it billed.
33Billing provider infoCUSTOM SMILES DENTISTRY, PLLC
ANDOVER, MN 55304
ANDOVER, MN 55304
33aNPI1528678497assigned 08/05/2020
33bProvider typeDental Clinic/Center
28Total paid$335K
24GClaims9,963
24DCodes billed14
24AFirst – last monthOct 2020 – Dec 2024
Compared with peers
Next to other Dental Clinic/Center providers in Minnesota
Rank by total paid#58 of 148
Median peer was paid$70K
This provider vs. median4.8×
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 | |
|---|---|---|---|
| 2020 | 32 | $712.88 | |
| 2021 | 268 | $5K | |
| 2022 | 2,397 | $79K | |
| 2023 | 3,107 | $101K | |
| 2024incomplete | 4,159 | $149K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1206 | Topical application of fluoride varnish | 12% | 1,360 | 1,359 | $40K |
| D0330 | Panoramic radiographic image | 12% | 443 | 443 | $39K |
| D1110 | Prophylaxis - adult | 11% | 659 | 659 | $38K |
| D0230 | Intraoral - periapical each additional radiographic image | 10% | 2,463 | 830 | $34K |
| D0274 | Bitewings - four radiographic images | 9.7% | 752 | 752 | $32K |
| D1351 | Sealant - per tooth | 9.0% | 801 | 164 | $30K |
| D0150 | Comprehensive oral evaluation - new or established patient | 8.4% | 626 | 625 | $28K |
| D1120 | Dental cleaning, childProphylaxis - child | 6.9% | 604 | 603 | $23K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 6.1% | 567 | 567 | $21K |
| D0220 | Intraoral - periapical first radiographic image | 5.0% | 972 | 962 | $17K |
| D0180 | 4.6% | 159 | 159 | $15K | |
| D1330 | 4.1% | 429 | 428 | $14K |
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 officialVANG, PAO CHUA (DENTIST)