THE SMILE STORE, LLC
NPI: 1629578539
· SEASIDE, OR 97138
· Denturist
· NPI assigned 02/16/2018
$110K
Total Medicaid Paid
Provider Details
| Authorized Official | CUNNING, KEITH (PRESIDENT) |
| NPI Enumeration Date | 02/16/2018 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
25 |
$386.40 |
| 2019 |
188 |
$3K |
| 2020 |
706 |
$9K |
| 2021 |
267 |
$7K |
| 2022 |
437 |
$46K |
| 2023 |
393 |
$21K |
| 2024 |
148 |
$23K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,441 |
1,375 |
$42K |
| D5110 |
|
58 |
54 |
$40K |
| D5120 |
|
30 |
27 |
$21K |
| D1999 |
|
635 |
421 |
$8K |