Dental
Lucky Smiles LLC
Lucky Smiles LLC was paid $424K by Medicaid between Apr 2024 and Dec 2024, across 14 billing codes. Its largest line is D2392, Resin-based composite - two surfaces, posterior, primary or permanent — 56% of everything it billed.
33Billing provider infoLUCKY SMILES LLC
LEWISVILLE, TX 75067
LEWISVILLE, TX 75067
33aNPI1730959834assigned 01/09/2024
33bProvider typeGeneral Practice Dentistry
28Total paid$424K
24GClaims9,259
24DCodes billed14
24AFirst – last monthApr 2024 – Dec 2024
Compared with peers
Next to other General Practice Dentistry providers in Texas
Rank by total paid#578 of 2,774
Median peer was paid$43K
This provider vs. median9.9×
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 | |
|---|---|---|---|
| 2024incomplete | 9,259 | $424K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 56% | 2,738 | 540 | $238K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 25% | 1,535 | 436 | $104K |
| D0150 | Comprehensive oral evaluation - new or established patient | 3.5% | 535 | 472 | $15K |
| D1120 | Dental cleaning, childProphylaxis - child | 3.3% | 459 | 409 | $14K |
| D1110 | Prophylaxis - adult | 2.3% | 219 | 199 | $10K |
| D0272 | Bitewings - two radiographic images | 2.2% | 462 | 412 | $9K |
| D1208 | Topical application of fluoride, excluding varnish | 2.0% | 700 | 631 | $9K |
| D0220 | Intraoral - periapical first radiographic image | 1.7% | 730 | 614 | $7K |
| D0274 | Bitewings - four radiographic images | 1.6% | 232 | 213 | $7K |
| D0230 | Intraoral - periapical each additional radiographic image | 1.3% | 640 | 562 | $6K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 1.0% | 160 | 160 | $4K |
| D1351 | Sealant - per tooth | <1% | 70 | 14 | $762.48 |
2 more codes
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 officialVALISHETTY, MAMATHA (MEMBER)
Parent organizationLUCKY SMILE LLC