Dental
Clubhouse Pediatric Dentistry of Jackson
Clubhouse Pediatric Dentistry of Jackson was paid $129K by Medicaid between Feb 2019 and Dec 2024, across 11 billing codes. Its largest line is D0120, dental checkup, returning patient — 30% of everything it billed.
33Billing provider infoCLUBHOUSE PEDIATRIC DENTISTRY OF JACKSON
JACKSON HOLE, WY 83001
JACKSON HOLE, WY 83001
33aNPI1942775960assigned 10/05/2018
33bProvider typePediatric Dentist
28Total paid$129K
24GClaims5,589
24DCodes billed11
24AFirst – last monthFeb 2019 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in Wyoming
Rank by total paid#10 of 16
Median peer was paid$454K
This provider vs. median0.3×
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 | 268 | $6K | |
| 2020 | 332 | $9K | |
| 2021 | 849 | $18K | |
| 2022 | 1,354 | $32K | |
| 2023 | 1,459 | $35K | |
| 2024incomplete | 1,327 | $27K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 30% | 1,342 | 1,237 | $38K |
| D1120 | Dental cleaning, childProphylaxis - child | 30% | 1,229 | 1,137 | $38K |
| D1208 | Topical application of fluoride, excluding varnish | 14% | 1,015 | 945 | $18K |
| D0220 | Intraoral - periapical first radiographic image | 8.3% | 784 | 715 | $11K |
| D0230 | Intraoral - periapical each additional radiographic image | 6.8% | 682 | 583 | $9K |
| D1351 | Sealant - per tooth | 4.4% | 209 | 56 | $6K |
| D0272 | Bitewings - two radiographic images | 3.6% | 237 | 225 | $5K |
| D1110 | Prophylaxis - adult | 2.1% | 50 | 50 | $3K |
| D0330 | Panoramic radiographic image | <1% | 16 | 16 | $1K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | <1% | 12 | 12 | $275.00 |
| D1206 | Topical application of fluoride varnish | <1% | 13 | 12 | $240.00 |
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 officialJACKSON, COURTNEY (PEDIATRIC DENTIST)