Clinic
SL Sample, DDS LLC
SL Sample, DDS LLC was paid $211K by Medicaid between Mar 2023 and Nov 2024, across 13 billing codes. Its largest line is D1110, Prophylaxis - adult — 20% of everything it billed.
33Billing provider infoSL SAMPLE, DDS LLC
CAMP SPRINGS, MD 20748
CAMP SPRINGS, MD 20748
33aNPI1770200883assigned 10/20/2022
33bProvider typeDental Clinic/Center
28Total paid$211K
24GClaims3,989
24DCodes billed13
24AFirst – last monthMar 2023 – Nov 2024
Compared with peers
Next to other Dental Clinic/Center providers in Maryland
Rank by total paid#68 of 133
Median peer was paid$216K
This provider vs. median1.0×
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 | |
|---|---|---|---|
| 2023 | 1,273 | $67K | |
| 2024incomplete | 2,716 | $144K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 20% | 652 | 649 | $43K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 17% | 278 | 144 | $37K |
| D0150 | Comprehensive oral evaluation - new or established patient | 16% | 618 | 614 | $35K |
| D0210 | Intraoral - complete series of radiographic images | 14% | 526 | 524 | $30K |
| D7210 | Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth | 8.7% | 164 | 87 | $18K |
| D0140 | Limited oral evaluation - problem focused | 7.0% | 314 | 308 | $15K |
| D1206 | Topical application of fluoride varnish | 6.5% | 531 | 528 | $14K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 5.4% | 360 | 360 | $11K |
| D1120 | Dental cleaning, childProphylaxis - child | 2.0% | 86 | 86 | $4K |
| D0220 | Intraoral - periapical first radiographic image | 1.5% | 309 | 290 | $3K |
| D1330 | <1% | 109 | 109 | $747.60 | |
| D0274 | Bitewings - four radiographic images | <1% | 30 | 30 | $722.10 |
1 more codes
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 12 | $98.40 |
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 officialSAMPLE, SHEMIKA (OWNER/DDS)