Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
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CLUBHOUSE PEDIATRIC DENTISTRY OF IDAHO FALLS

NPI: 1376028324 · IDAHO FALLS, ID 83404 · Pediatric Dentist · NPI assigned 09/26/2018

$5K
Total Medicaid Paid
283
Total Claims
268
Beneficiaries
5
Codes Billed
2019-02
First Month
2019-07
Last Month

Provider Details

Authorized OfficialROBISON, JENNIFER (CREDENTIALING COORDINATOR)
NPI Enumeration Date09/26/2018

Related Entities

Other providers sharing the same authorized official: ROBISON, JENNIFER

ProviderCityStateTotal Paid
CLUBHOUSE PEDIATRIC DENTISTRY OF MADISON REXBURG ID $1.89M
CLUBHOUSE PEDIATRIC DENTISTRY OF WEST JORDAN MIDVALE UT $0.00

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2019 283 $5K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D0150 Comprehensive oral evaluation - new or established patient 60 60 $4K
D1120 Prophylaxis - child 75 75 $1K
D1208 Topical application of fluoride, excluding varnish 26 26 $0.00
D0220 Intraoral - periapical first radiographic image 61 57 $0.00
D0230 Intraoral - periapical each additional radiographic image 61 50 $-88.03