SPECIAL SMILES LTD
NPI: 1639239296
· PHILADELPHIA, PA 19125
· General Practice Dentistry
· NPI assigned 12/12/2006
$8.54M
Total Medicaid Paid
Provider Details
Related Entities
Other providers sharing the same authorized official: GOLDSTEIN, MARK
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
878 |
$1.94M |
| 2019 |
876 |
$2.15M |
| 2020 |
488 |
$1.19M |
| 2021 |
1,305 |
$1.60M |
| 2024 |
670 |
$1.67M |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
3,425 |
3,423 |
$8.42M |
| D9920 |
|
190 |
188 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
195 |
194 |
$75.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
179 |
178 |
$40.00 |
| D1110 |
Prophylaxis - adult |
134 |
133 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$0.00 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
41 |
13 |
$0.00 |
| D9222 |
|
12 |
12 |
$0.00 |
| D4355 |
|
12 |
12 |
$0.00 |