Cosmetic Smiles Dental Care LLC

Cosmetic Smiles Dental Care LLC was paid $29K by Medicaid between Aug 2023 and Oct 2024, across 10 billing codes. Its largest line is D0210, Intraoral - complete series of radiographic images — 31% of everything it billed.

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
2023	578	$6K
2024incomplete	1,866	$23K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D0210	Intraoral - complete series of radiographic images	31%	216	215	$9K
D1110	Prophylaxis - adult	28%	413	411	$8K
D1208	Topical application of fluoride, excluding varnish	9.4%	289	286	$3K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	9.3%	219	218	$3K
D0150	Comprehensive oral evaluation - new or established patient	8.6%	267	266	$2K
D1330		4.5%	485	482	$1K
D0274	Bitewings - four radiographic images	3.7%	124	124	$1K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	3.6%	32	12	$1K
D0220	Intraoral - periapical first radiographic image	1.0%	230	227	$289.59
D0230	Intraoral - periapical each additional radiographic image	<1%	169	168	$185.19

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 officialMONTERO, SANDORF (MGR)