Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › UT › MIDVALE › CLUBHOUSE PEDIATRIC DENTISTRY OF WEST JORDAN

CLUBHOUSE PEDIATRIC DENTISTRY OF WEST JORDAN

NPI: 1639654684 · MIDVALE, UT 84047 · Pediatric Dentist · NPI assigned 09/26/2018

$0.00
Total Medicaid Paid
97
Total Claims
97
Beneficiaries
5
Codes Billed
2020-06
First Month
2021-07
Last Month

Provider Details

Authorized OfficialROBISON, JENNIFER (CREDENTIALING COORDINATOR)
Parent OrganizationCAPSTONE LLC
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 IDAHO FALLS IDAHO FALLS ID $5K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2020 37 $0.00
2021 60 $0.00

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
D0272 Bitewings - two radiographic images 12 12 $0.00
D1206 Topical application of fluoride varnish 25 25 $0.00
D0230 Intraoral - periapical each additional radiographic image 24 24 $0.00
D1120 Prophylaxis - child 12 12 $0.00
D0220 Intraoral - periapical first radiographic image 24 24 $0.00