Dental
South Hills Pediatric Dental Specialists, LLC
South Hills Pediatric Dental Specialists, LLC was paid $241K by Medicaid between Jun 2020 and Nov 2024, across 15 billing codes. Its largest line is D0120, dental checkup, returning patient — 48% of everything it billed.
33Billing provider infoSOUTH HILLS PEDIATRIC DENTAL SPECIALISTS, LLC
RIVERTON, UT 84096
RIVERTON, UT 84096
33aNPI1730714783assigned 03/10/2020
33bProvider typePediatric Dentist
28Total paid$241K
24GClaims8,684
24DCodes billed15
24AFirst – last monthJun 2020 – Nov 2024
Compared with peers
Next to other Pediatric Dentist providers in Utah
Rank by total paid#84 of 152
Median peer was paid$311K
This provider vs. median0.8×
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 | |
|---|---|---|---|
| 2020 | 304 | $9K | |
| 2021 | 1,712 | $52K | |
| 2022 | 3,329 | $96K | |
| 2023 | 1,932 | $48K | |
| 2024incomplete | 1,407 | $37K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 48% | 1,642 | 1,613 | $117K |
| D1120 | Dental cleaning, childProphylaxis - child | 14% | 1,794 | 1,767 | $35K |
| D0272 | Bitewings - two radiographic images | 10% | 922 | 902 | $24K |
| D0150 | Comprehensive oral evaluation - new or established patient | 6.9% | 105 | 100 | $17K |
| D1206 | Topical application of fluoride varnish | 6.1% | 1,965 | 1,930 | $15K |
| D0330 | Panoramic radiographic image | 5.9% | 102 | 96 | $14K |
| D0220 | Intraoral - periapical first radiographic image | 2.8% | 868 | 836 | $7K |
| D0230 | Intraoral - periapical each additional radiographic image | 2.1% | 952 | 552 | $5K |
| D7140 | Extraction, erupted tooth or exposed root | <1% | 59 | 25 | $2K |
| D1351 | Sealant - per tooth | <1% | 145 | 30 | $1K |
| D2140 | <1% | 38 | 24 | $1K | |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | <1% | 16 | 12 | $1K |
3 more codes
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 officialJACOBSEN, MATTHEW (OWNER)
| Provider | Location | Paid |
|---|---|---|
| Matthew Jacobsen Pediatric Dentistry | Riverton, UT | $0.00 |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.