Dental
Clubhouse Pediatric Dentistry of West Jordan
Clubhouse Pediatric Dentistry of West Jordan was paid $0.00 by Medicaid between Jun 2020 and Jul 2021, across 5 billing codes. Its largest line is D0272, Bitewings - two radiographic images — 0% of everything it billed.
33Billing provider infoCLUBHOUSE PEDIATRIC DENTISTRY OF WEST JORDAN
MIDVALE, UT 84047
MIDVALE, UT 84047
33aNPI1639654684assigned 09/26/2018
33bProvider typePediatric Dentist
28Total paid$0.00
24GClaims97
24DCodes billed5
24AFirst – last monthJun 2020 – Jul 2021
Compared with peers
Next to other Pediatric Dentist providers in Utah
Rank by total paid#151 of 152
Median peer was paid$311K
This provider vs. median0.0×
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 | |
|---|---|---|---|
| 2020 | 37 | $0.00 | |
| 2021 | 60 | $0.00 |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0272 | Bitewings - two radiographic images | 0% | 12 | 12 | $0.00 |
| D1206 | Topical application of fluoride varnish | 0% | 25 | 25 | $0.00 |
| D0230 | Intraoral - periapical each additional radiographic image | 0% | 24 | 24 | $0.00 |
| D1120 | Dental cleaning, childProphylaxis - child | 0% | 12 | 12 | $0.00 |
| D0220 | Intraoral - periapical first radiographic image | 0% | 24 | 24 | $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 officialROBISON, JENNIFER (CREDENTIALING COORDINATOR)
Parent organizationCAPSTONE LLC
| Provider | Location | Paid |
|---|---|---|
| Clubhouse Pediatric Dentistry of Madison | Rexburg, ID | $1.89M |
| Clubhouse Pediatric Dentistry of Idaho Falls | Idaho Falls, ID | $5K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.