Dental
Crystal Bright Smile INC
Crystal Bright Smile INC was paid $38K by Medicaid between Jun 2024 and Dec 2024, across 13 billing codes. Its largest line is D0150, Comprehensive oral evaluation - new or established patient — 33% of everything it billed.
33Billing provider infoCRYSTAL BRIGHT SMILE INC
TUJUNGA, CA 91042
TUJUNGA, CA 91042
33aNPI1790371409assigned 12/16/2020
33bProvider typeGeneral Practice Dentistry
28Total paid$38K
24GClaims1,249
24DCodes billed13
24AFirst – last monthJun 2024 – Dec 2024
Compared with peers
Next to other General Practice Dentistry providers in California
Rank by total paid#1,862 of 2,668
Median peer was paid$173K
This provider vs. median0.2×
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 | 1,249 | $38K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0150 | Comprehensive oral evaluation - new or established patient | 33% | 192 | 192 | $13K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 15% | 86 | 38 | $6K |
| D1110 | Prophylaxis - adult | 12% | 56 | 56 | $5K |
| D1120 | Dental cleaning, childProphylaxis - child | 12% | 115 | 115 | $5K |
| D0210 | Intraoral - complete series of radiographic images | 8.7% | 70 | 70 | $3K |
| D1208 | Topical application of fluoride, excluding varnish | 6.6% | 180 | 180 | $3K |
| D1351 | Sealant - per tooth | 5.3% | 54 | 14 | $2K |
| D0230 | Intraoral - periapical each additional radiographic image | 4.6% | 382 | 84 | $2K |
| D0272 | Bitewings - two radiographic images | 1.1% | 36 | 36 | $432.00 |
| D0220 | Intraoral - periapical first radiographic image | <1% | 19 | 19 | $228.00 |
| D1320 | <1% | 12 | 12 | $202.50 | |
| D1310 | 0% | 30 | 30 | $0.00 |
1 more codes
| D0603 | 0% | 17 | $0.00 |
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 officialDEMIRCHYAN, HENRY (ADMINISTRATOR)