Clinic
Shine Az LLC
Shine Az LLC was paid $74K by Medicaid between Jan 2018 and May 2021, across 12 billing codes. Its largest line is D1120, dental cleaning, child — 35% of everything it billed.
33Billing provider infoSHINE AZ LLC
GLENDALE, AZ 85308
GLENDALE, AZ 85308
33aNPI1689973679assigned 03/16/2011
33bProvider typeDental Clinic/Center
28Total paid$74K
24GClaims13,145
24DCodes billed12
24AFirst – last monthJan 2018 – May 2021
Compared with peers
Next to other Dental Clinic/Center providers in Arizona
Rank by total paid#23 of 70
Median peer was paid$7K
This provider vs. median11×
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 | |
|---|---|---|---|
| 2018 | 4,284 | $30K | |
| 2019 | 4,129 | $22K | |
| 2020 | 2,927 | $15K | |
| 2021 | 1,805 | $8K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 35% | 3,170 | 3,067 | $26K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 23% | 2,908 | 2,826 | $17K |
| D1206 | Topical application of fluoride varnish | 18% | 3,211 | 3,106 | $13K |
| D0272 | Bitewings - two radiographic images | 12% | 2,086 | 2,017 | $9K |
| D0150 | Comprehensive oral evaluation - new or established patient | 3.8% | 354 | 345 | $3K |
| D0220 | Intraoral - periapical first radiographic image | 2.2% | 613 | 581 | $2K |
| D1208 | Topical application of fluoride, excluding varnish | 1.7% | 193 | 186 | $1K |
| D0230 | Intraoral - periapical each additional radiographic image | 1.1% | 286 | 210 | $840.36 |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 1.1% | 214 | 189 | $803.17 |
| D1110 | Prophylaxis - adult | <1% | 41 | 40 | $693.84 |
| D0274 | Bitewings - four radiographic images | <1% | 30 | 30 | $310.25 |
| D1354 | <1% | 39 | 13 | $159.28 |
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 officialBOLESTA, JONATHAN (OWNER)