Dental
Pristinedental Center PC
Pristinedental Center PC was paid $115K by Medicaid between Nov 2020 and Dec 2024, across 16 billing codes. Its largest line is D1110, Prophylaxis - adult — 19% of everything it billed.
33Billing provider infoPRISTINEDENTAL CENTER PC
UPPER DARBY, PA 19082
UPPER DARBY, PA 19082
33aNPI1619455219assigned 08/06/2018
33bProvider typeDentist
28Total paid$115K
24GClaims4,758
24DCodes billed16
24AFirst – last monthNov 2020 – Dec 2024
Compared with peers
Next to other Dentist providers in Pennsylvania
Rank by total paid#193 of 683
Median peer was paid$34K
This provider vs. median3.3×
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 | 159 | $3K | |
| 2021 | 445 | $9K | |
| 2024incomplete | 4,154 | $102K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 19% | 678 | 674 | $22K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 16% | 206 | 175 | $19K |
| D0274 | Bitewings - four radiographic images | 15% | 657 | 654 | $17K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 13% | 810 | 806 | $15K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 12% | 174 | 151 | $14K |
| D0330 | Panoramic radiographic image | 8.0% | 277 | 276 | $9K |
| D0220 | Intraoral - periapical first radiographic image | 5.7% | 913 | 905 | $7K |
| D0230 | Intraoral - periapical each additional radiographic image | 3.7% | 618 | 615 | $4K |
| D1351 | Sealant - per tooth | 3.2% | 41 | 19 | $4K |
| D0140 | Limited oral evaluation - problem focused | <1% | 69 | 68 | $1K |
| D1208 | Topical application of fluoride, excluding varnish | <1% | 46 | 46 | $744.48 |
| D1120 | Dental cleaning, childProphylaxis - child | <1% | 38 | 38 | $536.83 |
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 officialSHAH, DHAVAL (DENTIST)