Dental
Jackson, Sara
Jackson, Sara was paid $43K by Medicaid between Jun 2022 and Mar 2024, across 11 billing codes. Its largest line is D1110, Prophylaxis - adult — 28% of everything it billed.
33Billing provider infoJACKSON, SARA
SAINT JOHN, IN 46373
SAINT JOHN, IN 46373
33aNPI1710546106assigned 06/10/2019
33bProvider typeGeneral Practice Dentistry
28Total paid$43K
24GClaims1,095
24DCodes billed11
24AFirst – last monthJun 2022 – Mar 2024
Compared with peers
Next to other General Practice Dentistry providers in Indiana
Rank by total paid#404 of 723
Median peer was paid$60K
This provider vs. median0.7×
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 | |
|---|---|---|---|
| 2022 | 183 | $6K | |
| 2023 | 799 | $31K | |
| 2024incomplete | 113 | $6K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 28% | 245 | 224 | $12K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 22% | 116 | 52 | $9K |
| D0150 | Comprehensive oral evaluation - new or established patient | 17% | 214 | 183 | $7K |
| D0140 | Limited oral evaluation - problem focused | 13% | 156 | 143 | $5K |
| D0274 | Bitewings - four radiographic images | 7.6% | 87 | 79 | $3K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 5.9% | 105 | 99 | $3K |
| D1120 | Dental cleaning, childProphylaxis - child | 2.2% | 39 | 33 | $931.50 |
| D0330 | Panoramic radiographic image | 2.1% | 12 | 12 | $883.96 |
| D0220 | Intraoral - periapical first radiographic image | 2.0% | 79 | 66 | $850.82 |
| D0272 | Bitewings - two radiographic images | <1% | 24 | 16 | $372.15 |
| D1206 | Topical application of fluoride varnish | <1% | 18 | 14 | $267.00 |
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.