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.

Sleepy Tooth Orthodontics LLC (NPI 1083230494)

Field	Value
Entity Type	Organization
Organization	Sleepy Tooth Orthodontics LLC
Address	26670 Centerview Dr Unit 19
City	Millsboro
State	DE
ZIP	19966
Taxonomy	Orthodontics and Dentofacial Orthopedics Dentistry
NPI Enumerated	June 22, 2020

Payer Source	Total Paid
Medicaid	$8.3M
Medicare	$0

Key Findings

This provider is effectively a Medicaid-focused practice: there is no Medicare billing on file and total Medicaid revenue is $8.3M, indicating a single-payer footprint concentrated in state Medicaid rather than a mixed Medicare/Medicaid payer mix. The NPI was enumerated on 2020-06-22 (~6 years ago), so the practice has been active under this enrollment for a multi-year period.

Revenue is highly concentrated in a handful of codes: the precomputed top three Medicaid codes (D8670, D8020, D8090) account for 87.8% of the provider's total Medicaid revenue. Individually those codes represent D8670 at 41.1%, D8020 at 29.3%, and D8090 at 17.3% of Medicaid revenue, so the business is materially dependent on a small set of services.

The code mix and the provider taxonomy (Orthodontics and Dentofacial Orthopedics Dentistry) align: a high-volume, lower-unit-payment code (D8670: 14.9K claims, $229 avg paid/claim, $3.4M revenue) is paired with fewer, higher-unit-payment codes (D8020: 1K claims, $2385 avg paid/claim, $2.4M revenue; D8090: 868 claims, $1654 avg paid/claim, $1.4M revenue). This pattern is consistent with an orthodontic operation that generates revenue through a combination of routine recurring visits or adjustments and a smaller number of higher-cost appliance or comprehensive treatment events.

Competitive standing within the state is meaningful but not dominant: the provider ranks #3 of 20 for D8670 (89th percentile), #2 of 9 for D8020 (88th percentile), and #3 of 12 for D8090 (82th percentile). Those ranks and percentiles are characterized in the source as "typical, unremarkable volume," indicating this practice is a notable participant in these code lines statewide but not an outlier or market monopolist.

There are multiple procedure codes with nonzero claim counts that report $0 avg paid/claim and $0 revenue (examples include D0350: 237 claims; D0603: 230 claims; D0340: 128 claims which ranks #1 of 3 providers in-state). These zero-paid claim lines together contribute 0.0% of reported Medicaid revenue and likely reflect submitted but non-reimbursed billings, adjustments, or services not covered under the payer configuration rather than material revenue sources.

The provider’s revenue profile mixes a very large-volume lower-unit service (D8670: 14.9K claims) with fewer high-unit-value procedures (D8020 and D8090), which creates both operational efficiency and revenue concentration exposure. Because the top three codes comprise 87.8% of Medicaid revenue, changes in reimbursement policy, authorization rules, or clinical utilization for any of these specific codes could materially affect the provider’s topline.

Given the $8.3M Medicaid-only revenue and the NPI tenure since 2020-06-22 (~6 years), this entity appears to be an established, Medicaid-focused orthodontic practice with a narrow service concentration. The combination of concentrated revenue and mid-range state percentile ranks suggests it is an established specialist in its niche market but not a statewide leader across all peers.

Medicaid: Complete Services Breakdown

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

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D8670	N/A	14,890	$230	$3.4M
D8020	N/A	1,020	$2,390	$2.4M
D8090	N/A	870	$1,650	$1.4M
D8660	N/A	2,710	$350	$941.7K
D0150	Comprehensive oral evaluation – new or established patient	1,300	$40	$55.7K
D0330	N/A	490	$40	$17K
D0350	N/A	240	$0	$0
D0602	N/A	190	$0	$0
D0603	Antigen testing for a public health-related pathogen, including coronavirus (COVID-19), using a high throughput technique, per day	230	$0	$0
D9310	N/A	30	$0	$0

Showing 1–10 of 12

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

Sleepy Tooth Orthodontics LLC — 0 of 6 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

12 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D8670	N/A	3	20	2,720	$230	$1.2M
D8020	N/A	2	10	120	$2,450	$950.3K
D8090	N/A	3	10	200	$1,910	$774.6K
D8660	N/A	3	10	810	$330	$422.7K
D0330	N/A	32	100	190	$70	$54.1K
D0150	Comprehensive oral evaluation – new or established patient	30	150	260	$60	$53.2K
D0350	N/A	7	20	110	$40	$29K
D0340	N/A	1	10	40	$1	$250
D0603	Antigen testing for a public health-related pathogen, including coronavirus (COVID-19), using a high throughput technique, per day	67	90	1,060	$1	$150
D0602	N/A	64	90	460	$1	$20

Showing 1–10 of 12

Nearby Providers

Other providers in the same ZIP code as Sleepy Tooth Orthodontics 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
Peninsula Dental, LLC	DE	General Practice Dentistry	$0	$12.3M
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

Sleepy Tooth Orthodontics LLC — Billing Profile & Reimbursement Data

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Sleepy Tooth Orthodontics 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