JACOBSEN, MATTHEW
NPI: 1952659708
· RIVERTON, UT 84096
· Pediatric Dentist
· NPI assigned 08/28/2012
$133K
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
229 |
$5K |
| 2020 |
547 |
$12K |
| 2021 |
959 |
$25K |
| 2022 |
965 |
$26K |
| 2023 |
1,448 |
$35K |
| 2024 |
1,195 |
$31K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,023 |
1,020 |
$69K |
| D1120 |
Prophylaxis - child |
1,256 |
1,253 |
$24K |
| D0272 |
Bitewings - two radiographic images |
844 |
843 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,250 |
1,242 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
57 |
57 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
496 |
496 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
417 |
379 |
$3K |