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

Why is the Medicaid comparison limited to Vermont 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. Vermont (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.

Middlebury Pediatric Dentistry, PLLC (NPI 1053937292)

Field	Value
Entity Type	Organization
Organization	Middlebury Pediatric Dentistry, PLLC
Address	132 S Village Grn
City	Middlebury
State	VT
ZIP	05753
Taxonomy	Pediatric Dentistry
NPI Enumerated	June 23, 2020

Payer Source	Total Paid
Medicaid	$2.9M
Medicare	$0

Key Findings

This practice is effectively single‑payer at the federal/state level: there is no Medicare billing on file and lifetime Medicaid revenue is cited as $2.9M, indicating Medicaid is the sole payer relationship represented in the claims dataset. The provider’s NPI was enumerated on 2020-06-23 (~6 years ago), so this billing footprint has accumulated since a relatively recent enrollment date.

Revenue is concentrated in a small set of pediatric preventive and evaluation codes: the top three Medicaid codes — D1120, D1206, and D0120 — together account for 42.0% of the provider’s total Medicaid revenue. Individually those codes generated $526.2K (D1120, 18.2%), $396K (D1206, 13.7%), and $294.6K (D0120, 10.2%), signaling that routine prophylaxis, topical fluoride, and periodic exams are the primary revenue drivers.

The code mix and descriptions point to a pediatric‑focused preventive practice model: D1120 (Prophylaxis–child), D1206 (Topical Fluoride Treatment), and D0120 (Periodic oral evaluation - established patient) are the top revenue contributors, and large volumes of sealant activity (D1351) and child prophylaxis (D1120) further emphasize a preventive, child‑centered service line rather than a specialty surgical or hospital‑based workflow. High counts for D1206 (17.2K claims) and D1120 (12.2K claims) indicate persistent, recurring preventive care provided to a large Medicaid pediatric population.

The provider is a strong state‑level competitor for multiple high‑volume pediatric codes: D1120 ranks #3 of 114 providers in‑state (98th percentile) and D1206 ranks #4 of 115 (97th percentile), both described as notably above typical state volume. Several other codes show competitive strength (for example, D0120 at the 95th percentile), so the practice behaves as a major regional provider of routine pediatric dental services within Vermont’s Medicaid network.

There are clear statistical outliers in the provider’s billing profile: D1354 (8.7K claims, $147.4K, 5.1%) ranks #1 of 24 providers in‑state (100th percentile) and is labeled an "extreme outlier, far above typical state volume for this code." Additional codes where the practice is the top biller or sole biller in‑state include D2930 (rank #1 of 7, 100th percentile), D0145 (rank #1 of 18, 100th percentile), and D3240 (rank #1 of 1 with no peer comparison available), underscoring unusually high relative activity on a subset of procedures.

While preventive care dominates, the practice also bills notable restorative and operative codes, indicating in‑office treatment capacity beyond screenings: D2392 (Post 2 surface resin‑based composite) generated $270.4K (9.3% of Medicaid revenue, 1.9K claims) and D2930 produced $117.5K (4.1%), showing meaningful restorative throughput alongside sealants and prophylaxis. The presence of D1110 (Prophylaxis – adult) at $118.2K (4.1%) suggests a smaller but nonzero volume of adult prophylaxis billed to Medicaid.

Operational scale is evident in raw claim volumes: D1206 has 17.2K claims, D1120 has 12.2K claims, and D1354 has 8.7K claims, which together reflect very high patient throughput for Medicaid dental services. These volumes are consistent with a high‑capacity pediatric practice model serving a large Medicaid population and explain the practice’s top percentile rankings on several codes.

Medicaid: Complete Services Breakdown

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

24 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D1120	Prophylaxis–child	12,240	$40	$526.2K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	17,220	$20	$396K
D0120	Periodic oral evaluation - established patient	9,500	$30	$294.6K
D2392	Post 2 surface resin‑based composite	1,900	$140	$270.4K
D0330	N/A	2,940	$70	$208.5K
D1351	Sealant - per tooth	5,640	$30	$180.5K
D0150	Comprehensive oral evaluation – new or established patient	2,820	$60	$160.5K
D1354	N/A	8,670	$20	$147.4K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	2,000	$60	$118.2K
D2930	N/A	740	$160	$117.5K

Showing 1–10 of 24

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Vermont Distribution

Middlebury Pediatric Dentistry, PLLC — 7 of 24 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. Vermont median

24 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D2392	Post 2 surface resin‑based composite	11	60	610	$130	$155.6K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	28	50	400	$80	$101.1K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	30	150	540	$50	$73.5K
D1351	Sealant - per tooth	9	40	480	$20	$63.9K
D2391	Resin‑based composite – one surface, posterior	24	50	310	$90	$62.9K
D9230	N/A	3	20	500	$50	$59.7K
D1120	Prophylaxis–child	3	110	220	$40	$59.2K
D0120	Periodic oral evaluation - established patient	9	160	720	$30	$57.8K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	4	120	500	$20	$53.5K
D0140	Limited oral evaluation – problem focused	26	70	560	$40	$53.3K

Showing 1–10 of 24

Nearby Providers

Other providers in the same ZIP code as Middlebury Pediatric Dentistry, PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Specialized Community Care, Inc	VT	Community/Behavioral Health Agency	$0	$60.9M
Counseling Service Of Addison County	VT	Developmental Disabilities Clinic/Center	$0	$59.6M
Counseling Service Of Addison County, Inc	VT	Clinic/Center	$0	$22.1M
Rainbow Pediatrics	VT	Pediatric Adolescent Medicine Physician	$0	$1.8M
Middlebury Volunteer Ambulance Association, Inc	VT	Ambulance	$508.9K	$1.3M
Porter Hospital, Inc	VT	Family Medicine Physician	$0	$1.3M
Brian Collins	VT	Pediatric Dentistry	$0	$606.8K
Middlebury Family Health	VT	Health Maintenance Organization	$0	$547.3K
Amy Gregory	VT	Ophthalmology Physician	$306.6K	$0
Elizabeth Keathley	VT	Clinical Psychologist	$0	$303.3K

Middlebury Pediatric Dentistry, PLLC — Billing Profile & Reimbursement Data

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Middlebury Pediatric Dentistry, PLLC — 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