Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers

LUCKY SMILES LLC

NPI: 1730959834 · LEWISVILLE, TX 75067 · General Practice Dentistry · NPI assigned 01/09/2024

$424K
Total Medicaid Paid
9,259
Total Claims
5,373
Beneficiaries
14
Codes Billed
2024-04
First Month
2024-12
Last Month

Provider Details

Authorized OfficialVALISHETTY, MAMATHA (MEMBER)
Parent OrganizationLUCKY SMILE LLC
NPI Enumeration Date01/09/2024

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2024 9,259 $424K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D2392 Resin-based composite - two surfaces, posterior, primary or permanent 2,738 540 $238K
D2391 Resin-based composite - one surface, posterior, primary or permanent 1,535 436 $104K
D0150 Comprehensive oral evaluation - new or established patient 535 472 $15K
D1120 Prophylaxis - child 459 409 $14K
D1110 Prophylaxis - adult 219 199 $10K
D0272 Bitewings - two radiographic images 462 412 $9K
D1208 Topical application of fluoride, excluding varnish 700 631 $9K
D0220 Intraoral - periapical first radiographic image 730 614 $7K
D0274 Bitewings - four radiographic images 232 213 $7K
D0230 Intraoral - periapical each additional radiographic image 640 562 $6K
D0120 Periodic oral evaluation - established patient 160 160 $4K
D1351 Sealant - per tooth 70 14 $762.48
D9230 Inhalation of nitrous oxide / analgesia, anxiolysis 53 41 $406.65
D0603 726 670 $0.00