SIMPLY DENTAL OF LONDONDERRY MILES OF SMILES

NPI: 1881305928 · LONDONDERRY, NH 03053 · Dental Clinic/Center · NPI assigned 12/09/2022

$104K

Total Medicaid Paid

3,113

Total Claims

2,972

Beneficiaries

Codes Billed

2023-03

First Month

2024-12

Last Month

Provider Details

Authorized Official	HODGERNEY, AIMEE (CREDENTIALING MANAGER)
NPI Enumeration Date	12/09/2022

Other providers sharing the same authorized official: HODGERNEY, AIMEE

Provider	City	State	Total Paid
PEDIATRIC DENTISTRY AND ORTHODONTICS PLLC	NEW BRITAIN	CT	$4.90M
NINE WEST MAIN DENTAL, LLC	WEST BROOKFIELD	MA	$1.02M
SIMPLY ORTHODONTICS OF MARLBOROUGH, PLLC	MARLBOROUGH	MA	$162K
SUPER DENTAL OF WORCESTER PLLC	WORCESTER	MA	$120K
SIMPLY DENTAL AND ORTHODONTICS OF WAYLAND ,PLLC	WAYLAND	MA	$19K

Year	Claims	Total Paid
2023	1,706	$53K
2024	1,407	$51K

Code	Description	Claims	Beneficiaries	Total Paid
D1120	Prophylaxis - child	683	656	$25K
D0120	Periodic oral evaluation - established patient	732	720	$25K
D1206	Topical application of fluoride varnish	718	699	$15K
D1110	Prophylaxis - adult	257	250	$14K
D0274	Bitewings - four radiographic images	259	255	$9K
D1208	Topical application of fluoride, excluding varnish	278	270	$5K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	26	14	$3K
D0150	Comprehensive oral evaluation - new or established patient	50	47	$3K
D0330	Panoramic radiographic image	49	46	$2K
D1351	Sealant - per tooth	61	15	$2K