Dental
Pediatric Dentistry and Orthodontics of Jackson
Pediatric Dentistry and Orthodontics of Jackson was paid $1.11M by Medicaid between Mar 2022 and Dec 2024, across 19 billing codes. Its largest line is D2930, Prefabricated stainless steel crown - primary tooth — 28% of everything it billed.
33Billing provider infoPEDIATRIC DENTISTRY AND ORTHODONTICS OF JACKSON
JACKSON, MI 49201
JACKSON, MI 49201
33aNPI1952058133assigned 03/07/2022
33bProvider typeOrthodontics and Dentofacial Orthopedic Dentist
28Total paid$1.11M
24GClaims18,953
24DCodes billed19
24AFirst – last monthMar 2022 – Dec 2024
Compared with peers
Next to other Orthodontics and Dentofacial Orthopedic Dentist providers in Michigan
Rank by total paid#3 of 10
Median peer was paid$302K
This provider vs. median3.7×
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 | 2,984 | $153K | |
| 2023 | 7,176 | $464K | |
| 2024incomplete | 8,793 | $497K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D2930 | Prefabricated stainless steel crown - primary tooth | 28% | 1,606 | 709 | $313K |
| D7140 | Extraction, erupted tooth or exposed root | 14% | 1,551 | 808 | $153K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 11% | 922 | 566 | $118K |
| D1120 | Dental cleaning, childProphylaxis - child | 6.8% | 1,654 | 1,654 | $76K |
| D0150 | Comprehensive oral evaluation - new or established patient | 5.8% | 1,013 | 1,012 | $65K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 5.2% | 580 | 393 | $58K |
| D0230 | Intraoral - periapical each additional radiographic image | 4.5% | 3,635 | 1,620 | $50K |
| D1206 | Topical application of fluoride varnish | 4.3% | 1,602 | 1,600 | $48K |
| D0220 | Intraoral - periapical first radiographic image | 3.7% | 2,150 | 2,116 | $41K |
| D0140 | Limited oral evaluation - problem focused | 3.7% | 644 | 636 | $41K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 3.1% | 891 | 889 | $35K |
| D0240 | 2.3% | 1,265 | 725 | $26K |
7 more codes
| D9248 | 2.3% | 191 | $25K | |
| D1351 | Sealant - per tooth | 1.7% | 553 | $19K |
| D3220 | Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction | 1.1% | 92 | $12K |
| D9310 | <1% | 103 | $10K | |
| D0272 | Bitewings - two radiographic images | <1% | 308 | $8K |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 162 | $7K |
| D1510 | <1% | 31 | $7K |
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 officialVAN, LY (PEDIATRIC DENTIST)