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 South Dakota for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Childrens Dental Center (NPI 1033276530)

Field	Value
Entity Type	Organization
Organization	Childrens Dental Center
Address	3813 S Kiwanis Cir
City	Sioux Falls
State	SD
ZIP	57105
Taxonomy	Pediatric Dentistry
NPI Enumerated	January 3, 2007

Payer Source	Total Paid
Medicaid	$24M
Medicare	$0

Key Findings

CHILDRENS DENTAL CENTER reports $24M in lifetime Medicaid revenue and has no Medicare billing on file, making it effectively a single-payer (Medicaid) practice in the available claims data. This concentration on Medicaid should be treated as the primary commercial exposure when evaluating payer risk and reimbursement sensitivity for this entity.

Revenue concentration is notable: the top 3 Medicaid codes by revenue account for 35.9% of this provider's total Medicaid revenue, led by D2930 ($4.6M, 19.3%), D1120 (50.3K claims, $2M, 8.5%), and D0120 (61.5K claims, $1.9M, 8.1%). These three codes together drive more than one-third of Medicaid receipts, so changes to reimbursement or utilization for these services would disproportionately affect overall revenue.

The provider’s code mix and descriptions indicate a primarily pediatric-preventive service model: very high volumes for D1120 (Prophylaxis–child, 50.3K claims, $2M) and D0120 (Periodic oral evaluation - established patient, 61.5K claims, $1.9M), plus D1206 (Topical Fluoride Treatment, 74.1K claims, $1.9M) and D1351 (Sealant - per tooth, 40.1K claims, $1.3M). This pattern is consistent with a high-throughput pediatric dentistry practice that emphasizes routine cleanings, exams, fluoride, and sealants as core revenue drivers.

Operative and surgical procedures are also a meaningful part of the mix, showing substantial volumes and revenue for restorative and extraction codes: D2392 (13.3K claims, $1.3M), D2391 (12.8K claims, $1M), and D7140 (14.5K claims, $1.2M). The presence of both high-volume preventive codes and significant restorative/extraction revenue indicates the practice manages a full range of pediatric dental needs rather than only screening visits.

COMPETITIVE standing within South Dakota is dominant on many codes: D1120, D0120, D1206, D1351, D2392 and several others rank #1 in-state and are labeled as extreme outliers at the 100th percentile, while D2930 ranks #2 of 11 providers (90th percentile). These top-rank and percentile labels point to market leadership in pediatric dental services across multiple procedures rather than typical or modest participation.

Imaging and diagnostic work also appear at scale: D0210 (Intraoral complete series, 5.4K claims, $529.9K) ranks #2 of 41 providers (98th percentile; extreme outlier) and D0220 (Intraoral periapical first image, 14K claims, $238.5K) ranks #2 of 87 providers (99th percentile; extreme outlier). High relative rank on diagnostic codes suggests frequent use of radiography to support the high preventive and operative case mix.

The NPI was enumerated on 2007-01-03 (~19 years ago), indicating an established presence in Sioux Falls; that tenure, combined with persistent high volumes across preventive and operative codes, supports characterization as a long-standing regional pediatric dental provider. Historic presence may contribute to referral patterns and patient volume that sustain the large claim counts observed.

From an operational and reimbursement risk perspective, the practice’s heavy reliance on a small set of Medicaid services is material: with $24M total Medicaid revenue and the top 3 codes accounting for 35.9% of that revenue, policy or coverage changes affecting D2930, D1120, or D0120 could disproportionately impact margins and cash flow. Analysts evaluating contract negotiation or network adequacy should prioritize how these specific pediatric preventive and common restorative codes are reimbursed by payers.

Medicaid: Complete Services Breakdown

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

35 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D2930	N/A	25,360	$180	$4.6M
D1120	Prophylaxis–child	50,330	$40	$2M
D0120	Periodic oral evaluation - established patient	61,520	$30	$1.9M
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	74,080	$30	$1.9M
D1351	Sealant - per tooth	40,130	$30	$1.3M
D2392	Post 2 surface resin‑based composite	13,330	$100	$1.3M
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	14,520	$90	$1.2M
D2391	Resin‑based composite – one surface, posterior	12,770	$80	$1M
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	18,470	$60	$1M
D0272	N/A	32,080	$30	$930.3K

Showing 1–10 of 35

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Childrens Dental Center — 21 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

35 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D2930	N/A	2	10	230	$180	$1.3M
D2390	N/A	1	10	2,130	$200	$420.9K
D9420	N/A	2	10	640	$160	$317.3K
D3220	N/A	1	10	720	$100	$297.4K
D1510	N/A	1	10	890	$180	$161.4K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	2	40	260	$90	$151.5K
D1351	Sealant - per tooth	1	50	400	$30	$117.3K
D2391	Resin‑based composite – one surface, posterior	2	40	150	$80	$115.5K
D2330	Resin-based composite - one surface, anterior	2	10	500	$90	$101.9K
D2392	Post 2 surface resin‑based composite	1	60	100	$100	$89.5K

Showing 1–10 of 35

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Dakota Achieve	SD	Developmental Disabilities Clinic/Center	$0	$166.9M
Dakotabilities	SD	Voluntary or Charitable Agency	$0	$77.8M
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Volunteers Of America, Dakotas	SD	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$60.9M
Southeastern Behavioral Healthcare	SD	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$59.1M
Resouces For Human Development, Inc.	SD	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$31.1M
Sanford Medical Center	SD	General Acute Care Hospital	$0	$24.4M
Sanford Medical Center	SD	Air Ambulance	$0	$11.9M
Avera Mckennan	SD	Family Medicine Physician	$0	$10.6M
Sanford Clinic	SD	Pediatrics Physician	$0	$5.5M

Childrens Dental Center — Billing Profile & Reimbursement Data

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Childrens Dental Center — 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