Clinic
Pure Smile Dental Group
Pure Smile Dental Group was paid $41K by Medicaid between May 2024 and Nov 2024, across 9 billing codes. Its largest line is D1110, Prophylaxis - adult — 20% of everything it billed.
33Billing provider infoPURE SMILE DENTAL GROUP
SOUTH SAN FRANCISCO, CA 94080
SOUTH SAN FRANCISCO, CA 94080
33aNPI1609141274assigned 03/15/2012
33bProvider typeDental Clinic/Center
28Total paid$41K
24GClaims634
24DCodes billed9
24AFirst – last monthMay 2024 – Nov 2024
Compared with peers
Next to other Dental Clinic/Center providers in California
Rank by total paid#818 of 1,135
Median peer was paid$200K
This provider vs. median0.2×
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 | 634 | $41K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 20% | 81 | 81 | $8K |
| D0150 | Comprehensive oral evaluation - new or established patient | 18% | 101 | 101 | $7K |
| D1999 | 16% | 84 | 81 | $7K | |
| D4341 | 16% | 77 | 24 | $7K | |
| D0210 | Intraoral - complete series of radiographic images | 13% | 91 | 91 | $5K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 12% | 61 | 24 | $5K |
| D1206 | Topical application of fluoride varnish | 3.1% | 63 | 63 | $1K |
| D1208 | Topical application of fluoride, excluding varnish | <1% | 14 | 14 | $265.10 |
| D0350 | 0% | 62 | 62 | $0.00 |
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 officialKOTROB, MOUTAZ (OWNER)