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.

Delaware Pediatric Dentistry (NPI 1063971745)

Field	Value
Entity Type	Organization
Organization	Delaware Pediatric Dentistry
Address	625 N Dupont Blvd
City	Milford
State	DE
ZIP	19963
Taxonomy	Pediatric Dentistry
NPI Enumerated	March 13, 2019

Payer Source	Total Paid
Medicaid	$18.1M
Medicare	$0

Key Findings

DELAWARE PEDIATRIC DENTISTRY is classified under Pediatric Dentistry and has an NPI enumeration date of 2019-03-13 (~7 years ago), indicating it has been active in Medicaid billing for several years since initial registration. The provider is based in MILFORD, DE and the dataset shows a focused pediatric dental operation rather than a broad multi-specialty practice.

This provider reports no Medicare revenue on file and $18.1M in lifetime Medicaid revenue, making its activity effectively single-payer Medicaid in scale. Analysts should treat Medicare-market comparisons as not applicable for this entity and concentrate competitive analysis on Medicaid patterns.

Revenue is highly concentrated among a small set of dental codes: the top 3 Medicaid codes (D2930, D1351, D1120) account for 35.6% of the provider’s total Medicaid revenue. Individually those codes are D2930 ($2.8M, 16.0%), D1351 ($1.9M, 10.9%), and D1120 ($1.5M, 8.6%), so a minority of code lines contributes a large share of receipts.

The code mix shows a heavy emphasis on pediatric preventive services and routine care: D1351 (Sealant - per tooth) appears at 44K claims with $1.9M revenue, D1120 (Prophylaxis–child) at 27.8K claims with $1.5M revenue, and D1206 (Topical Fluoride Treatment) at 33.5K claims with $1.1M revenue. High volumes of D0120 (Periodic oral evaluation) at 23.4K claims and D0150 (Comprehensive oral evaluation) at 10.2K claims further support that the practice delivers high-throughput preventive and diagnostic pediatric dentistry.

In addition to preventive care, the practice reports substantial restorative and surgical activity: D2391 (one-surface posterior composite) produced $1.2M (6.9% of Medicaid revenue) with 6.2K claims, D2392 produced $1.2M (6.8%) with 4.8K claims, and D7140 (extraction) produced $1.2M (6.6%) with 6.8K claims. The presence of these higher-paid restorative and extraction codes alongside high preventive volumes suggests a full-service pediatric dental workflow that includes both routine and operative care.

Competitively this provider is a dominant in-state player on numerous codes: it ranks #1 statewide for D2930 (100th percentile; extreme outlier), D1351 (100th percentile; extreme outlier), D7140 (100th percentile; extreme outlier), D0240 (100th percentile; extreme outlier), and several other codes. Multiple #1 ranks and repeated 100th-percentile designations indicate volume levels far above typical state peers and a leading market position in Delaware Medicaid pediatric dental services.

Several procedure lines are flagged as statistical outliers in the state dataset—explicitly labelled in the source as “extreme outlier” or “notably above typical”—including D2930, D1351, D7140, D1206, D0120, and D0150. These labels, together with the provider’s top ranks, demonstrate unusually high utilization relative to in-state peers and should be a focus for comparative utilization and capacity analysis.

From a business-profile perspective, the combination of single-payer dependence (no Medicare revenue) and concentration in a handful of high-volume pediatric codes (top 3 = 35.6% of Medicaid revenue) means the practice’s revenue is sensitive to Medicaid policy, reimbursement changes, or shifts in pediatric patient flow. For payers and network planners, this profile signals both an established pediatric capacity in the region and a potential vulnerability to reimbursement or utilization shifts centered on a small set of services.

Medicaid: Complete Services Breakdown

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

43 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D2930	N/A	10,080	$280	$2.8M
D1351	Sealant - per tooth	44,030	$40	$1.9M
D1120	Prophylaxis–child	27,830	$60	$1.5M
D2391	Resin‑based composite – one surface, posterior	6,180	$200	$1.2M
D2392	Post 2 surface resin‑based composite	4,820	$250	$1.2M
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	6,770	$170	$1.2M
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	33,450	$30	$1.1M
D0120	Periodic oral evaluation - established patient	23,410	$40	$1M
D0240	N/A	24,900	$30	$771.8K
D0150	Comprehensive oral evaluation – new or established patient	10,160	$70	$660.3K

Showing 1–10 of 43

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

Delaware Pediatric Dentistry — 19 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

43 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D2930	N/A	1	30	580	$260	$446.8K
D2392	Post 2 surface resin‑based composite	9	90	490	$220	$366.3K
D2940	N/A	1	10	2,340	$140	$322.4K
D2393	Resin-based composite, three surfaces, posterior	20	40	260	$270	$226.1K
D1351	Sealant - per tooth	1	70	1,690	$40	$217.1K
D2391	Resin‑based composite – one surface, posterior	3	70	320	$180	$192K
D1120	Prophylaxis–child	2	120	960	$50	$163.3K
D2390	N/A	1	10	90	$460	$140.8K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	1	60	270	$140	$137K
D9230	N/A	23	30	900	$70	$121.1K

Showing 1–10 of 43

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bayhealth Medical Center, Inc.	DE	General Acute Care Hospital	$0	$39.5M
Banyan Delaware LLC	DE	Substance Abuse Rehabilitation Facility	$0	$30.9M
Bayada Home Health Care, Inc.	DE	Home Health Agency	$0	$28.5M
Epic Health Services (de), LLC	DE	Home Health Agency	$0	$19.3M
Kent-sussex Industries	DE	Developmentally Disabled Services Day Training Agency	$0	$11.7M
Nurses 'n Kids Of Milford, Inc.	DE	Medically Fragile Infants and Children Day Care	$0	$9.5M
Prn Staffers Inc	DE	Home Health Agency	$0	$7.6M
People's Place Ii, Inc.	DE	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$4.9M
Bayhealth Medical Center, Inc.	DE	Clinic/Center	$0	$3.7M
La Red Health Center, Inc.	DE	Federally Qualified Health Center (FQHC)	$0	$2.7M

Delaware Pediatric Dentistry — Billing Profile & Reimbursement Data

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Delaware Pediatric Dentistry — 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