Dental
Jackson Pediatric Dentistry PC
Jackson Pediatric Dentistry PC was paid $8.08M by Medicaid between Oct 2019 and Dec 2024, across 28 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 14% of everything it billed.
33Billing provider infoJACKSON PEDIATRIC DENTISTRY PC
JACKSON, MI 49203
JACKSON, MI 49203
33aNPI1255870051assigned 02/14/2017
33bProvider typePediatric Dentist
28Total paid$8.08M
24GClaims160,372
24DCodes billed28
24AFirst – last monthOct 2019 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Michigan
Rank by total paid#6 of 153
Median peer was paid$464K
This provider vs. median17×
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 | |
|---|---|---|---|
| 2019 | 3,004 | $199K | |
| 2020 | 22,329 | $1.35M | |
| 2021 | 31,776 | $1.64M | |
| 2022 | 33,010 | $1.52M | |
| 2023 | 37,826 | $1.84M | |
| 2024incomplete | 32,427 | $1.53M |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 14% | 6,057 | 2,630 | $1.14M |
| D1120 | Dental cleaning, childProphylaxis - child | 13% | 25,378 | 25,368 | $1.02M |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 12% | 8,455 | 4,133 | $1.00M |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 11% | 27,246 | 27,233 | $884K |
| D1206 | Topical application of fluoride varnish | 9.2% | 28,301 | 28,282 | $747K |
| D7140 | Extraction, erupted tooth or exposed root | 5.7% | 5,309 | 2,704 | $457K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 5.3% | 4,780 | 3,031 | $432K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 4.8% | 3,050 | 1,659 | $385K |
| D0272 | Bitewings - two radiographic images | 3.9% | 13,705 | 13,686 | $312K |
| D1351 | Sealant - per tooth | 3.6% | 9,900 | 2,858 | $288K |
| D1110 | Prophylaxis - adult | 2.2% | 3,610 | 3,610 | $175K |
| D2332 | 1.8% | 1,246 | 789 | $148K |
16 more codes
| D0150 | Comprehensive oral evaluation - new or established patient | 1.7% | 2,570 | $141K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 1.6% | 930 | $133K |
| D2330 | 1.4% | 1,424 | $110K | |
| D9248 | 1.3% | 1,641 | $107K | |
| D0330 | Panoramic radiographic image | 1.2% | 1,548 | $98K |
| D0140 | Limited oral evaluation - problem focused | 1.1% | 1,558 | $91K |
| D0240 | 1.0% | 4,095 | $81K | |
| D0210 | Intraoral - complete series of radiographic images | <1% | 1,092 | $78K |
| D1510 | <1% | 394 | $76K | |
| D0220 | Intraoral - periapical first radiographic image | <1% | 3,204 | $56K |
| D2934 | <1% | 220 | $45K | |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 2,598 | $33K |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 652 | $26K |
| D2331 | <1% | 119 | $12K | |
| D1208 | Topical application of fluoride, excluding varnish | <1% | 151 | $4K |
| D9986 | 0% | 1,139 | $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 officialDAVENPORT, STEVEN (OWNER)
| Provider | Location | Paid |
|---|---|---|
| Southwoods Health at Home, LLC | Youngstown, OH | $70K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.