Dental
Clubhouse Pediatric Dentistry of Madison
Clubhouse Pediatric Dentistry of Madison was paid $1.89M by Medicaid between Oct 2018 and Dec 2024, across 22 billing codes. Its largest line is D1120, dental cleaning, child — 36% of everything it billed.
33Billing provider infoCLUBHOUSE PEDIATRIC DENTISTRY OF MADISON
REXBURG, ID 83440
REXBURG, ID 83440
33aNPI1306321351assigned 09/26/2018
33bProvider typePediatric Dentist
28Total paid$1.89M
24GClaims95,853
24DCodes billed22
24AFirst – last monthOct 2018 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Idaho
Rank by total paid#14 of 53
Median peer was paid$394K
This provider vs. median4.8×
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 | 3,791 | $78K | |
| 2019 | 16,075 | $300K | |
| 2020 | 13,526 | $266K | |
| 2021 | 14,431 | $287K | |
| 2022 | 17,970 | $349K | |
| 2023 | 15,289 | $307K | |
| 2024incomplete | 14,771 | $300K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 36% | 9,386 | 9,372 | $679K |
| D0274 | Bitewings - four radiographic images | 16% | 2,521 | 2,517 | $308K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 14% | 3,734 | 1,701 | $255K |
| D0330 | Panoramic radiographic image | 7.4% | 1,258 | 1,257 | $139K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 6.1% | 3,151 | 1,522 | $115K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 4.5% | 771 | 267 | $85K |
| D7140 | Extraction, erupted tooth or exposed root | 4.2% | 2,145 | 1,151 | $78K |
| D0150 | Comprehensive oral evaluation - new or established patient | 3.5% | 1,062 | 1,059 | $67K |
| D1110 | Prophylaxis - adult | 3.3% | 3,200 | 3,194 | $61K |
| D9420 | 2.7% | 344 | 344 | $50K | |
| D0140 | Limited oral evaluation - problem focused | 1.8% | 1,462 | 1,429 | $35K |
| D1351 | Sealant - per tooth | <1% | 13,644 | 2,965 | $7K |
10 more codes
| D1206 | Topical application of fluoride varnish | <1% | 2,383 | $6K |
| D0120 | Dental checkup, returning patient | <1% | 11,402 | $719.05 |
| D2331 | <1% | 27 | $377.81 | |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | <1% | 303 | $264.51 |
| D0220 | Intraoral - periapical first radiographic image | <1% | 10,437 | $215.93 |
| D0170 | <1% | 20 | $114.52 | |
| D0272 | Bitewings - two radiographic images | <1% | 6,595 | $63.04 |
| D1208 | Topical application of fluoride, excluding varnish | 0% | 9,723 | $-13.51 |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 0% | 2,711 | $-546.87 |
| D0230 | Intraoral - periapical each additional radiographic image | 0% | 9,574 | $-945.20 |
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 officialROBISON, JENNIFER (FINANCIAL COORDINATOR)
| Provider | Location | Paid |
|---|---|---|
| Clubhouse Pediatric Dentistry of Idaho Falls | Idaho Falls, ID | $5K |
| Clubhouse Pediatric Dentistry of West Jordan | Midvale, UT | $0.00 |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.