Dental
Jackson Pediatric Dentistry of Summerville
Jackson Pediatric Dentistry of Summerville was paid $443K by Medicaid between Oct 2018 and Dec 2024, across 19 billing codes. Its largest line is D1120, dental cleaning, child — 21% of everything it billed.
33Billing provider infoJACKSON PEDIATRIC DENTISTRY OF SUMMERVILLE
SUMMERVILLE, SC 29483
SUMMERVILLE, SC 29483
33aNPI1962981142assigned 08/09/2018
33bProvider typePediatric Dentist
28Total paid$443K
24GClaims16,355
24DCodes billed19
24AFirst – last monthOct 2018 – Dec 2024
Compared with peers
Next to other Pediatric Dentist providers in South Carolina
Rank by total paid#59 of 86
Median peer was paid$1.24M
This provider vs. median0.4×
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 | 12 | $486.00 | |
| 2019 | 490 | $13K | |
| 2020 | 1,350 | $39K | |
| 2021 | 2,995 | $76K | |
| 2022 | 3,849 | $104K | |
| 2023 | 3,656 | $92K | |
| 2024incomplete | 4,003 | $118K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D1120 | Dental cleaning, childProphylaxis - child | 21% | 2,789 | 2,789 | $92K |
| D1206 | Topical application of fluoride varnish | 12% | 3,365 | 3,365 | $52K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 11% | 2,263 | 2,263 | $50K |
| D9230 | Inhalation of nitrous oxide / analgesia, anxiolysis | 10% | 1,502 | 1,324 | $46K |
| D2930 | Prefabricated stainless steel crown - primary tooth | 8.8% | 306 | 110 | $39K |
| D0272 | Bitewings - two radiographic images | 7.0% | 1,737 | 1,737 | $31K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 5.2% | 227 | 122 | $23K |
| D0150 | Comprehensive oral evaluation - new or established patient | 4.2% | 472 | 472 | $19K |
| D0140 | Limited oral evaluation - problem focused | 4.0% | 481 | 479 | $18K |
| D0220 | Intraoral - periapical first radiographic image | 3.7% | 1,344 | 1,324 | $17K |
| D1110 | Prophylaxis - adult | 3.6% | 364 | 364 | $16K |
| D0145 | Oral evaluation for a patient under three years of age | 3.3% | 256 | 256 | $15K |
7 more codes
| D0230 | Intraoral - periapical each additional radiographic image | 2.1% | 909 | $9K |
| D7140 | Extraction, erupted tooth or exposed root | 1.8% | 79 | $8K |
| D1351 | Sealant - per tooth | <1% | 108 | $3K |
| D9310 | <1% | 47 | $3K | |
| D0330 | Panoramic radiographic image | <1% | 50 | $2K |
| D0274 | Bitewings - four radiographic images | <1% | 44 | $1K |
| D1208 | Topical application of fluoride, excluding varnish | <1% | 12 | $145.80 |
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, JEFFREY (OWNER)
| Provider | Location | Paid |
|---|---|---|
| SJHMC Physician Services | Phoenix, AZ | $46.65M |
| Dignity Health | Glendale, AZ | $5.61M |
| Dignity Health | Litchfield Park, AZ | $4.45M |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.