Holzer Dental Clinic Jackson LLC

Holzer Dental Clinic Jackson LLC was paid $74K by Medicaid between Jan 2018 and Mar 2020, across 11 billing codes. Its largest line is D1110, Prophylaxis - adult — 26% of everything it billed.

33Billing provider infoHOLZER DENTAL CLINIC JACKSON LLC
JACKSON, OH 45640

33aNPI1295783074assigned 05/04/2006

33bProvider typeDentist

28Total paid$74K

24GClaims2,837

24DCodes billed11

24AFirst – last monthJan 2018 – Mar 2020

Compared with peers

Next to other Dentist providers in Ohio

Rank by total paid#304 of 745

Median peer was paid$38K

This provider vs. median1.9×

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	1,626	$43K
2019	969	$25K
2020	242	$6K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1110	Prophylaxis - adult	26%	596	556	$19K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	20%	906	861	$15K
D2391	Resin-based composite - one surface, posterior, primary or permanent	17%	252	174	$12K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	17%	237	157	$12K
D0274	Bitewings - four radiographic images	5.6%	219	206	$4K
D1208	Topical application of fluoride, excluding varnish	4.5%	221	212	$3K
D1120	Dental cleaning, childProphylaxis - child	4.2%	156	151	$3K
D0330	Panoramic radiographic image	3.2%	65	60	$2K
D1206	Topical application of fluoride varnish	1.9%	97	94	$1K
D0272	Bitewings - two radiographic images	<1%	45	44	$451.50
D0220	Intraoral - periapical first radiographic image	<1%	43	38	$155.25

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 officialDERROW, SHERI (OFFICE MANAGER)