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

Why is the Medicaid comparison limited to Unspecified Location 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. Unspecified Location (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.

Michelle Grayson (NPI 1114489101)

NPI 1114489101 · Toronto, ZZ · Endodontics

Michelle Grayson is a endodontics provider located in Toronto, Unspecified Location. This profile covers 0 Medicare and 2 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services. Note: "ZZ" is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; claims coded under it are grouped and benchmarked here the same way a traditional state would be.

NPI 1114489101 · Toronto, ZZ · Endodontics

Provider details (source: NPPES NPI Registry)

Field	Value
Entity Type	Individual
Organization	Michelle Grayson
Address	43 Overbrook Place
City	Toronto
State	ZZ (Unspecified Location)
ZIP	M3H4P
Taxonomy	Endodontics
NPI Enumerated	April 1, 2019

Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

Payer Source	Total Paid
Medicaid	$1.6K
Medicare	$0

This provider has no Medicare billing on file and only $1.6K in lifetime Medicaid revenue, which makes its public-payer footprint de minimis; for analysts, MICHELLE GRAYSON should be treated as effectively single-payer (Medicaid-only) at the present data resolution rather than a multi-payer practice. The absence of Medicare revenue means national-level Medicare comparisons are not applicable for this NPI.

Revenue is highly concentrated: the precomputed top-3 Medicaid codes account for 100.0% of the provider’s Medicaid revenue, with D1110 representing 70.5% and D0120 representing 29.5% of Medicaid receipts. This concentration indicates that virtually all reported Medicaid activity is captured by a very small set of preventive/evaluation codes.

The top Medicaid code, D1110 (Prophylaxis - adult; cleaning and polishing of the teeth), accounts for $1.1K in revenue from 17 claims at $67 avg paid/claim, and ranks #2 of 3 providers in-state (50th percentile; typical, unremarkable volume). This rank and claim count point to modest, routine provision of adult prophylaxis under Medicaid rather than high-volume specialty procedures.

The second Medicaid code, D0120 (Periodic oral evaluation - established patient), accounts for $476 in revenue from 14 claims at $34 avg paid/claim and ranks #5 of 5 providers in-state (0th percentile; typical, unremarkable volume). That placement at the bottom of the state ranking indicates very low relative volume for periodic evaluations among in-state Medicaid providers.

Taxonomy and code mix divergence: the provider is listed as Endodontics, yet the Medicaid revenue mix is dominated by D1110 and D0120 (preventive and periodic evaluation codes). This suggests the billed Medicaid activity is primarily routine preventive visits rather than endodontic specialty procedures, which may reflect limited specialty-case capture or that the NPI is used for general preventative services in the Medicaid population.

Claim-level economics are modest: the dataset shows 17 claims at $67 avg paid/claim for D1110 and 14 claims at $34 avg paid/claim for D0120, producing $1.1K and $476 of Medicaid revenue respectively. Those low claim counts and payment levels reinforce that Medicaid contributes only a small absolute dollar amount to the provider’s lifetime public-payer revenue.

Competitive implication: with $1.6K total Medicaid revenue and percentile ranks described as "typical, unremarkable volume" or at the 0th percentile for listed codes, this provider is a minor participant in the in-state Medicaid market for the services shown. For payer or provider network strategy, MICHELLE GRAYSON represents limited Medicaid volume and minimal leverage for network-wide impact.

Tenure: the NPI was enumerated on 2019-04-01 (~7 years ago), indicating the provider has been registered for several years but has not developed measurable Medicare billing and has produced only modest Medicaid billing during that enrollment window. This relatively recent but multi-year presence with low public-payer activity suggests any growth or change in payer mix would be visible in future claim trends rather than in historical Medicaid or Medicare totals.

Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.

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

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	20	$70	$1.1K
D0120	Periodic oral evaluation - established patient	10	$30	$480

How this provider's Medicaid billing volume and revenue compare to other Unspecified Location providers billing the same CPT/HCPCS codes. Note: "ZZ" is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; claims coded under it are benchmarked here as their own state-equivalent group.

Full comparison — all codes billed, vs. Unspecified Location median

Michelle Grayson — Billing Profile & Reimbursement Data

Sign up for Michelle Grayson — Billing Profile & Reimbursement Data policy alerts

Michelle Grayson — Billing Profile & Reimbursement Data

Sign up for Michelle Grayson — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Frequently Asked Questions

References

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D0120	Periodic oral evaluation - established patient	5	10	40	$20	$1.4K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	2	10	20	$50	$1.2K