Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Delaware for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Delaware only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Delaware (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Peninsula Dental, LLC (NPI 1013145366)

Field	Value
Entity Type	Organization
Organization	Peninsula Dental, LLC
Address	26670 Centerview Dr Unit 19
City	Millsboro
State	DE
ZIP	19966
Taxonomy	General Practice Dentistry
NPI Enumerated	June 25, 2009

Payer Source	Total Paid
Medicaid	$12.3M
Medicare	$0

Key Findings

PENINSULA DENTAL, LLC has no Medicare billing on file and is effectively a single-payer (Medicaid) provider in these datasets, with Total Medicaid revenue of $12.3M. The absence of Medicare claims indicates the practice’s patient mix and reimbursement exposure are concentrated in the Medicaid population rather than dual-eligible or fee-for-service Medicare patients.

Revenue concentration within Medicaid is moderate: the precomputed top 3 Medicaid codes by revenue account for 32.0% of the provider’s total Medicaid revenue. This indicates a reliance on a relatively small set of dental procedures for a large share of revenue while still maintaining substantial revenue diversity across many other codes.

The code-level mix signals a general-practice, high-volume pediatric and preventive focus. High volumes and revenue for D1351 (Sealant - per tooth), D0120 (Periodic oral evaluation - established patient), and D1120 (Prophylaxis–child) — each among the top revenue contributors — suggest routine preventive services for children and ongoing recall care form a core service line.

Several codes position the practice as a statewide outlier on volume: D0120 (21.1K claims) ranks #4 of 158 providers in-state at the 98th percentile and is labeled an "extreme outlier, far above typical state volume," and D1110 (8.8K claims) ranks #2 of 163 providers at the 99th percentile and is similarly an extreme outlier. These rankings indicate PENINSULA DENTAL is a major provider for routine adult and established-patient evaluations and cleanings within Delaware Medicaid.

Other preventive and diagnostic codes also show unusually high state volume: D1206 (23.9K claims, 97th percentile), D1351 (20.8K claims, 94th percentile), D0274 (7.7K claims, 98th percentile), and D0230 (14.4K claims, 98th percentile) are described as notably above typical or extreme outliers. Collectively, these patterns point to a high-throughput clinic model with heavy use of sealants, fluoride, radiographs, and routine exams.

Restorative procedure volumes are meaningful but less dominant: resin-based composite codes D2392 (4.8K claims) and D2930 (4.4K claims) each generate roughly $1.1M combined and rank in the high percentiles (90th and 88th respectively). Their presence alongside very large preventive volumes suggests the practice provides a full general-dentistry scope, handling both prevention and common restorative needs.

High-average-paid but lower-claim-volume specialty procedures (for example D8090 and D9223 with $1949 and $1332 avg paid/claim respectively) contribute meaningful revenue in smaller counts and rank around the mid-state percentiles. These codes indicate the practice occasionally bills more complex or higher-cost services, supplementing the high-volume preventive base.

The provider has long tenure in the NPI registry, enumerated on 2009-06-25 (~17 years ago). This extended presence combined with the high state rankings on core codes suggests an established operation with sustained Medicaid activity and likely entrenched referral or patient retention patterns in its local market.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

42 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D8670	N/A	8,660	$200	$1.7M
D2392	Post 2 surface resin‑based composite	4,810	$220	$1.1M
D2930	N/A	4,390	$240	$1.1M
D1351	Sealant - per tooth	20,770	$40	$893.2K
D0120	Periodic oral evaluation - established patient	21,100	$40	$843.9K
D1120	Prophylaxis–child	15,290	$50	$810.1K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	23,890	$30	$740.7K
D2391	Resin‑based composite – one surface, posterior	3,440	$190	$640.2K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	8,770	$70	$622.6K
D8090	N/A	220	$1,950	$430.7K

Showing 1–10 of 42

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Delaware providers billing the same CPT/HCPCS codes.

Claims Volume vs. Delaware Distribution

Peninsula Dental, LLC — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

42 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D8670	N/A	5	20	2,720	$230	$1.2M
D8020	N/A	5	10	120	$2,450	$950.3K
D8090	N/A	6	10	200	$1,910	$774.6K
D9223	N/A	6	20	220	$130	$498.3K
D2930	N/A	4	30	580	$260	$446.8K
D8660	N/A	9	10	810	$330	$422.7K
D2392	Post 2 surface resin‑based composite	10	90	490	$220	$366.3K
D2393	Resin-based composite, three surfaces, posterior	27	40	260	$270	$226.1K
D1351	Sealant - per tooth	5	70	1,690	$40	$217.1K
D2391	Resin‑based composite – one surface, posterior	7	70	320	$180	$192K

Showing 1–10 of 42

Nearby Providers

Other providers in the same ZIP code as Peninsula Dental, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
National Mentor Healthcare, LLC	DE	Intellectual & Developmental Disabilities Psychologist	$0	$108.7M
Coras Wellness And Behavioral Health, LLC	DE	Substance Use Disorder Rehabilitation Clinic/Center	$703K	$18.2M
Sleepy Tooth Orthodontics LLC	DE	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$8.3M
Ctm Medical Associates LLC	DE	Surgery Physician	$0	$1.9M
Green Valley Terrace Snf LLC	DE	Skilled Nursing Facility	$0	$822K
Georges Dahr	DE	Cardiovascular Disease Physician	$763.7K	$0
Millsboro Fire Company Inc.	DE	Land Ambulance	$517.4K	$165.3K
Mid Sussex Rescue Squad Inc.	DE	Ambulance	$497.1K	$178K
William Singleton	DE	Addiction (Substance Use Disorder) Counselor	$0	$636.8K
Beebe Medical Center, Inc.	DE	Home Health Agency	$0	$559.9K

Peninsula Dental, LLC — Billing Profile & Reimbursement Data

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Peninsula Dental, LLC — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References