Dental
Green Mountain Pediatric Dentistry, PLLC
Green Mountain Pediatric Dentistry, PLLC was paid $1.29M by Medicaid between Aug 2019 and Dec 2024, across 31 billing codes. Its largest line is D2392, Resin-based composite - two surfaces, posterior, primary or permanent — 22% of everything it billed.
33Billing provider infoGREEN MOUNTAIN PEDIATRIC DENTISTRY, PLLC
SOUTH BURLINGTON, VT 05403
SOUTH BURLINGTON, VT 05403
33aNPI1912469297assigned 04/04/2019
33bProvider typePediatric Dentist
28Total paid$1.29M
24GClaims36,756
24DCodes billed31
24AFirst – last monthAug 2019 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Vermont
Rank by total paid#3 of 6
Median peer was paid$814K
This provider vs. median1.6×
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 | |
|---|---|---|---|
| 2019 | 563 | $21K | |
| 2020 | 4,509 | $92K | |
| 2021 | 4,454 | $75K | |
| 2023 | 8,461 | $289K | |
| 2024incomplete | 18,769 | $810K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 22% | 2,009 | 910 | $283K |
| D1351 | Sealant - per tooth | 8.9% | 6,397 | 877 | $114K |
| D1120 | Dental cleaning, childProphylaxis - child | 8.8% | 2,649 | 2,297 | $113K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 8.4% | 1,904 | 1,494 | $108K |
| D1354 | 6.7% | 4,499 | 778 | $86K | |
| D0150 | Comprehensive oral evaluation - new or established patient | 5.3% | 1,178 | 996 | $69K |
| D1206 | Topical application of fluoride varnish | 5.0% | 2,500 | 2,194 | $64K |
| D0272 | Bitewings - two radiographic images | 4.1% | 1,947 | 1,706 | $53K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 4.0% | 460 | 237 | $52K |
| D0220 | Intraoral - periapical first radiographic image | 3.8% | 2,415 | 2,057 | $49K |
| D0330 | Panoramic radiographic image | 3.7% | 591 | 507 | $47K |
| D0230 | Intraoral - periapical each additional radiographic image | 3.4% | 2,952 | 1,752 | $44K |
19 more codes
| D0120 | Dental checkup, returning patient | 3.4% | 1,450 | $44K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 3.4% | 222 | $44K |
| D9310 | 1.7% | 345 | $22K | |
| D7140 | Extraction, erupted tooth or exposed root | 1.5% | 162 | $19K |
| D1110 | Prophylaxis - adult | 1.1% | 239 | $14K |
| D0274 | Bitewings - four radiographic images | 1.1% | 311 | $14K |
| D1330 | <1% | 1,607 | $12K | |
| D0140 | Limited oral evaluation - problem focused | <1% | 165 | $9K |
| D2332 | <1% | 50 | $8K | |
| D1208 | Topical application of fluoride, excluding varnish | <1% | 484 | $7K |
| D2930 | Prefabricated stainless steel crown - primary tooth | <1% | 35 | $5K |
| D1510 | <1% | 14 | $3K | |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | <1% | 34 | $3K |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 30 | $1K |
| D0601 | 0% | 71 | $0.00 | |
| D0603 | 0% | 710 | $0.00 | |
| D0602 | 0% | 138 | $0.00 | |
| D1310 | 0% | 55 | $0.00 | |
| D1999 | 0% | 1,133 | $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 officialJACOBSON, BARRY (OWNER)
| Provider | Location | Paid |
|---|---|---|
| Laser Dentistry for Children LLC | Flushing, NY | $12.37M |
| Pediatric Dentistry of Kingston PLLC | Kingston, NY | $12.26M |
| North Country Pediatric Dentistry PLLC | Plattsburgh, NY | $9.49M |
| LDFCB Dentistry | Bronx, NY | $8.66M |
| New Jersey Laser Dentistry | Teaneck, NJ | $8.50M |
| Pediatric Dentistry of Monsey | Suffern, NY | $5.54M |
| Pediatric Dentistry of Albany, PLLC | Albany, NY | $3.91M |
| Laser Dentistry for Children | Teaneck, NJ | $1.17M |
| Pediatric Dentistry on Park PLLC | New York, NY | $392K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.