Jolly, Tesa

Jolly, Tesa was paid $239K by Medicaid between Jan 2018 and Aug 2019, across 17 billing codes. Its largest line is D1120, dental cleaning, child — 16% of everything it billed.

33Billing provider infoJOLLY, TESA
PULASKI, TN 38478

33aNPI1891930293assigned 12/13/2008

33bProvider typeDentist

28Total paid$239K

24GClaims8,348

24DCodes billed17

24AFirst – last monthJan 2018 – Aug 2019

Compared with peers

Next to other Dentist providers in Tennessee

Rank by total paid#103 of 242

Median peer was paid$164K

This provider vs. median1.5×

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
2018	4,919	$140K
2019	3,429	$99K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
D1120	Dental cleaning, childProphylaxis - child	16%	1,203	1,190	$38K
D1206	Topical application of fluoride varnish	13%	1,588	1,567	$30K
D0120	Dental checkup, returning patientPeriodic oral evaluation - established patient	13%	1,304	1,290	$30K
D2392	Resin-based composite - two surfaces, posterior, primary or permanent	11%	394	285	$27K
D9230	Inhalation of nitrous oxide / analgesia, anxiolysis	11%	911	821	$25K
D1110	Prophylaxis - adult	8.4%	496	488	$20K
D0330	Panoramic radiographic image	7.7%	429	425	$18K
D0274	Bitewings - four radiographic images	6.5%	603	592	$15K
D2391	Resin-based composite - one surface, posterior, primary or permanent	6.2%	251	207	$15K
D0272	Bitewings - two radiographic images	4.5%	609	600	$11K
D1351	Sealant - per tooth	1.2%	108	42	$3K
D7140	Extraction, erupted tooth or exposed root	<1%	35	26	$2K

5 more codes

D2930	Prefabricated stainless steel crown - primary tooth	<1%	16	$2K
D0220	Intraoral - periapical first radiographic image	<1%	118	$1K
D0140	Limited oral evaluation - problem focused	<1%	16	$292.80
D0230	Intraoral - periapical each additional radiographic image	<1%	22	$167.68
D9986		0%	245	$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.