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

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

Children's Dental Health Associates (NPI 1124041561)

Field	Value
Entity Type	Organization
Organization	Children's Dental Health Associates
Address	519 Baltimore Pike
City	Chadds Ford
State	PA
ZIP	19317
Taxonomy	Pediatric Dentistry
NPI Enumerated	July 26, 2006

Payer Source	Total Paid
Medicaid	$40.6M
Medicare	$0

Key Findings

This provider is effectively single‑payer: there is no Medicare billing on file while lifetime Medicaid revenue totals $40.6M, indicating that Medicaid is the primary and near‑exclusive revenue source reported for this NPI. Analysts should treat Medicaid policy and rate changes as the dominant financial levers for this entity.

Revenue is highly concentrated in a small set of procedures: the precomputed top‑three Medicaid codes (D2930, D1120, D0120) account for 37.8% of total Medicaid revenue. Specifically, D2930 generated $6.5M (16.5%), D1120 generated $4.5M (11.3%), and D0120 generated $4M (10.0%), signaling dependency on a narrow bundle of high‑yield codes.

The taxonomy and code mix indicate a pediatric‑focused, high‑throughput dental operation: the NPI is listed as Pediatric Dentistry and top codes include D1120 (Prophylaxis–child), D0120 (Periodic oral evaluation - established patient), D1206 (Topical Fluoride Treatment), and D1351 (Sealant - per tooth). These codes—combined with large claim volumes—point to a practice model centered on routine preventive and early restorative care for children, with additional capacity for extractions and restorative procedures.

State competitive standing is dominant for core services: the provider ranks #1 in‑state (100th percentile) for many of its highest‑revenue Medicaid codes (including D2930, D1120, D0120, D1206, D7140, and others), repeatedly described as an "extreme outlier" and far above typical state volume. This pattern identifies the organization as a major, market‑leading pediatric dental billing entity within Pennsylvania.

Operational scale is very large for individual procedures: several codes have six‑figure claim counts (for example, D1206: 168.3K claims; D0120: 141.4K claims; D1120: 131.4K claims; D1330: 107K claims), demonstrating substantial patient throughput and high visit frequency that underpin the $40.6M Medicaid revenue base. These volumes suggest clinic networks or high‑volume scheduling and throughput practices.

The payer mix and per‑claim payments show a mix of low‑paid, high‑frequency preventive services and higher‑paid restorative codes: for example, D2930 averaged $142 paid/claim, D1120 averaged $34 paid/claim, D0120 averaged $28 paid/claim, and D1206 averaged $22 paid/claim. This mix implies revenue driven by volume for preventive care with episodic higher payments for specific restorative procedures.

Concentration and outlier status create policy sensitivity: with 37.8% of Medicaid revenue tied to the top three codes and many top codes flagged as "extreme outlier, far above typical state volume," the provider’s financial performance is particularly exposed to changes in Medicaid coverage, payment rates, or state coding audits affecting those high‑volume services. Payors evaluating contract or program changes should prioritize impact modeling on these specific codes.

The NPI tenure indicates established presence: the provider was enumerated on 2006-07-26 (~20 years ago), suggesting long‑standing participation in Medicaid and likely entrenched referral or enrollment relationships that help explain sustained high volumes and statewide market leadership.

Medicaid: Complete Services Breakdown

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

48 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D2930	N/A	45,850	$140	$6.5M
D1120	Prophylaxis–child	131,400	$30	$4.5M
D0120	Periodic oral evaluation - established patient	141,350	$30	$4M
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	168,320	$20	$3.7M
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	33,970	$80	$2.6M
D2392	Post 2 surface resin‑based composite	32,470	$80	$2.5M
D9230	N/A	48,880	$40	$2.1M
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	41,610	$40	$1.8M
D0274	N/A	51,500	$30	$1.7M
D2391	Resin‑based composite – one surface, posterior	22,450	$70	$1.5M

Showing 1–10 of 48

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Children's Dental Health Associates — 25 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

48 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D9420	N/A	9	10	130	$1,640	$1.5M
D8670	N/A	72	250	310	$250	$253.5K
D8080	N/A	43	80	70	$980	$237.5K
D2930	N/A	1	200	290	$200	$223.1K
D2933	N/A	1	20	110	$210	$102.3K
D3230	N/A	1	10	470	$170	$99.8K
D2934	N/A	1	10	380	$240	$96.7K
D9920	N/A	97	140	130	$120	$56.9K
D2929	N/A	1	10	40	$420	$55.5K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	1	710	230	$70	$49.7K

Showing 1–10 of 48

Nearby Providers

Other providers in the same ZIP code as Children's Dental Health Associates, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Gwr Medical, Inc.	PA	Durable Medical Equipment & Medical Supplies	$0	$50.1M
Chadds Ford Ambulatory Surgical Center, LLC	PA	Ambulatory Surgical Clinic/Center	$1.5M	$0
Christa Cavanaugh	PA	Physician Assistant	$142.9K	$0
Matthew Costa	PA	Sports Medicine (Family Medicine) Physician	$141.3K	$0
Kathleen Breslin	PA	Clinical Neuropsychologist	$104.4K	$0
Jennifer Chu	PA	Neurology Physician	$81.6K	$0
Gina Marefat	PA	Speech-Language Pathologist	$60.6K	$0
Nicole Sestito	PA	Clinical Neuropsychologist	$56.3K	$0

Children's Dental Health Associates — Billing Profile & Reimbursement Data

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Children's Dental Health Associates — 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