Clinic
San Jose Dental Surgery Center, INC.
San Jose Dental Surgery Center, INC. was paid $12.84M by Medicaid between Jan 2018 and Dec 2024, across 41 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 26% of everything it billed.
33Billing provider infoSAN JOSE DENTAL SURGERY CENTER, INC.
SAN JOSE, CA 95122
SAN JOSE, CA 95122
33aNPI1902086606assigned 11/09/2007
33bProvider typeDental Clinic/Center
28Total paid$12.84M
24GClaims241,964
24DCodes billed41
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Dental Clinic/Center providers in California
Rank by total paid#23 of 1,135
Median peer was paid$200K
This provider vs. median64×
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 | |
|---|---|---|---|
| 2018 | 46,183 | $2.01M | |
| 2019 | 42,408 | $2.27M | |
| 2020 | 24,269 | $1.26M | |
| 2021 | 32,362 | $1.72M | |
| 2022 | 35,022 | $2.01M | |
| 2023 | 33,996 | $1.97M | |
| 2024incomplete | 27,724 | $1.60M |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 26% | 28,813 | 4,838 | $3.34M |
| 41899 | Unlisted procedure, dentoalveolar structures | 16% | 1,955 | 1,944 | $2.08M |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 12% | 15,969 | 3,961 | $1.57M |
| D7140 | Extraction, erupted tooth or exposed root | 6.4% | 14,477 | 4,725 | $817K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 4.8% | 11,287 | 11,253 | $611K |
| D1510 | 4.2% | 3,357 | 2,103 | $539K | |
| D1120 | Dental cleaning, childProphylaxis - child | 4.1% | 15,272 | 15,232 | $525K |
| D9420 | 3.5% | 6,065 | 5,217 | $445K | |
| D2150 | Silver amalgam - two surfaces, primary or permanent | 3.4% | 6,712 | 2,708 | $439K |
| D0150 | Comprehensive oral evaluation - new or established patient | 2.6% | 5,279 | 5,264 | $331K |
| D0230 | Intraoral - periapical each additional radiographic image | 2.3% | 64,030 | 16,330 | $300K |
| D2140 | 2.0% | 4,789 | 2,328 | $256K |
29 more codes
| D2330 | 1.8% | 3,075 | $230K | |
| D1351 | Sealant - per tooth | 1.7% | 7,453 | $212K |
| 00170 | Anesthesia for intraoral procedures, including biopsy | 1.3% | 1,814 | $161K |
| D1208 | Topical application of fluoride, excluding varnish | 1.2% | 15,268 | $150K |
| 99231 | Subsequent hospital care, per day, straightforward or low complexity | 1.1% | 1,142 | $147K |
| D0350 | 1.0% | 8,101 | $135K | |
| D0220 | Intraoral - periapical first radiographic image | <1% | 8,198 | $94K |
| D0272 | Bitewings - two radiographic images | <1% | 6,673 | $78K |
| 99232 | Hospital visit by a doctor, follow-up day | <1% | 920 | $75K |
| D0274 | Bitewings - four radiographic images | <1% | 3,348 | $71K |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 970 | $55K |
| D1310 | <1% | 989 | $44K | |
| 99218 | <1% | 1,292 | $39K | |
| 99199 | Unlisted special service, procedure or report | <1% | 471 | $22K |
| D0210 | Intraoral - complete series of radiographic images | <1% | 331 | $14K |
| 0360 | <1% | 152 | $14K | |
| D0603 | <1% | 623 | $9K | |
| 99070 | <1% | 932 | $8K | |
| J3490 | Unclassified drugs | <1% | 230 | $6K |
| D9430 | <1% | 174 | $5K | |
| 0490 | <1% | 111 | $5K | |
| 96360 | Intravenous infusion, hydration; initial, 31 minutes to 1 hour | <1% | 134 | $3K |
| 0760 | <1% | 124 | $3K | |
| D0601 | <1% | 187 | $3K | |
| 0710 | <1% | 124 | $2K | |
| J7120 | Ringers lactate infusion, up to 1000 cc | <1% | 319 | $2K |
| J7030 | Infusion, normal saline solution , 1000 cc | <1% | 179 | $2K |
| D2160 | <1% | 17 | $1K | |
| 99221 | 0% | 608 | $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 officialNGUYEN, KHAM (VICE PRESIDENT)