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

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

Smiles 4 Kids Caldwell (NPI 1144661844)

Field	Value
Entity Type	Organization
Organization	Smiles 4 Kids Caldwell
Address	4111 Clock Tower Ave
City	Caldwell
State	ID
ZIP	83607
Taxonomy	Pediatric Dentistry
NPI Enumerated	July 10, 2013

Payer Source	Total Paid
Medicaid	$8.5M
Medicare	$0

Key Findings

This provider is effectively a single‑payer Medicaid operator: there is no Medicare billing on file and lifetime Medicaid revenue is $8.5M, with an NPI enumerated 2013-07-10 (~13 years ago). The absence of Medicare suggests this entity’s patient base and revenue stream are dominated by Medicaid-covered dental services rather than dual Medicare/Medicaid mixes common among adult-focused practices.

Revenue is highly concentrated in a small set of preventive and diagnostic codes: the top 3 Medicaid codes by revenue account for 61.1% of total Medicaid revenue. Specifically, D1120 (36.3K claims, $76 avg paid/claim, $2.8M revenue (32.5% of this provider's total Medicaid revenue)), D1110 (13.6K claims, $111 avg paid/claim, $1.5M revenue (17.8% of this provider's total Medicaid revenue)), and D0210 (4.7K claims, $197 avg paid/claim, $919.2K revenue (10.8% of this provider's total Medicaid revenue)) together dominate billing and indicate dependence on a narrow set of high‑volume services.

The code mix and the provider taxonomy (Pediatric Dentistry) point to a preventive pediatric orientation with substantial diagnostic activity: heavy billing for D1120 (Prophylaxis–child), D0210 (Intraoral - complete series of radiographic images), D0150 (Comprehensive oral evaluation – new or established patient) and high sealant activity (D1351) are consistent with a high‑throughput pediatric preventive program. At the same time, the presence of D1110 (Prophylaxis - adult) in the top revenue drivers indicates meaningful adult prophylaxis billing despite the pediatric taxonomy, suggesting the practice may treat mixed age cohorts or bills adult‑coded cleanings.

Competitive standing within Idaho is dominant for multiple core codes: D1120 ranks #2 of 247 providers in-state (100th percentile; extreme outlier), D0210 ranks #1 of 117 providers in-state (100th percentile; extreme outlier), and D0150 ranks #1 of 217 providers in-state (100th percentile; extreme outlier). D1110 also ranks highly at #3 of 318 providers in-state (99th percentile; extreme outlier), indicating this provider is a major statewide participant for both child and adult prophylaxis and for complete radiographic series.

Several high‑volume claim lines contribute little or no revenue on a per‑claim basis, which affects revenue composition: D1206 shows 48.6K claims with $0 avg paid/claim, and D0230 lists 111.5K claims with $0 avg paid/claim, while D1351 has 69.1K claims at $1 avg paid/claim. These high claim counts with minimal average payment suggest a substantial portion of activity is either low‑reimbursement preventive care or reflects program/payment policy and reporting characteristics that materially reduce revenue per encounter.

Beyond prevention, the practice reports substantial operative/restorative volume: D2930 (12.4K claims, $63 avg paid/claim, $783.9K revenue (9.2% of this provider's total Medicaid revenue)) and D2391 (3.9K claims, $57 avg paid/claim, $224.5K revenue (2.6%)) signal meaningful restorative procedures, and D7140 (3.7K claims, $36 avg paid/claim, $131.8K revenue (1.6%)) indicates extractions are performed at scale. D2930’s rank (#3 of 54 providers in-state; 96th percentile; notably above typical state volume for this code) underscores that these are not marginal services for the practice but a significant operational line.

Imaging and adjunct diagnostic services are a consistent throughput driver: D0274 (15.4K claims, $30 avg paid/claim, $462.4K revenue (5.4%)) ranks #2 of 259 providers in-state (100th percentile; extreme outlier), and D0330 (4.9K claims, $15 avg paid/claim, $73.1K revenue (0.9%)) ranks #4 of 167 providers in-state (98th percentile; extreme outlier). The combination of high radiographic and complete series volumes reinforces a workflow that prioritizes diagnostic imaging as part of routine visits.

For analyst follow‑up, the combination of heavy Medicaid concentration ($8.5M), extreme‑percentile rankings on multiple codes, and very large claim counts with low or $0 avg paid/claim suggests areas to examine further such as patient age mix, payer contract/payment policies, coding patterns, and capacity. These patterns are factual markers of business scale and specialization rather than determinations of compliance; they flag this provider as a significant statewide Medicaid participant with concentrated preventive and diagnostic service lines.

Medicaid: Complete Services Breakdown

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

29 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D1120	Prophylaxis–child	36,300	$80	$2.8M
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	13,630	$110	$1.5M
D0210	Intraoral - complete series of radiographic images	4,670	$200	$919.2K
D2930	N/A	12,440	$60	$783.9K
D0150	Comprehensive oral evaluation – new or established patient	7,340	$70	$528.5K
D9420	N/A	1,680	$300	$497K
D0274	N/A	15,410	$30	$462.4K
D2391	Resin‑based composite – one surface, posterior	3,940	$60	$224.5K
D0145	N/A	3,600	$60	$215.9K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	3,660	$40	$131.8K

Showing 1–10 of 29

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Smiles 4 Kids Caldwell — 11 of 23 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

29 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D2930	N/A	3	50	750	$70	$171.2K
D1120	Prophylaxis–child	2	250	180	$60	$143K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	3	320	310	$80	$80.8K
D9420	N/A	3	40	180	$150	$80.8K
D2392	Post 2 surface resin‑based composite	54	190	280	$60	$72.9K
D2934	N/A	4	10	190	$280	$70.8K
D0210	Intraoral - complete series of radiographic images	1	120	140	$120	$66K
D0145	N/A	3	30	370	$50	$44K
D0330	N/A	4	170	170	$50	$35.6K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	7	110	300	$30	$32.4K

Showing 1–10 of 29

Nearby Providers

Other providers in the same ZIP code as Smiles 4 Kids Caldwell, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Vallivue School District #139	ID	Local Education Agency (LEA)	$0	$17M
Canyon County Ambulance District	ID	Ambulance	$950.5K	$7.4M
Patrick Waite	ID	General Practice Dentistry	$0	$1.1M
Southwest District Health	ID	Public Health or Welfare Agency	$0	$809.5K
Canyon Creek Developmental Services	ID	Local Education Agency (LEA)	$0	$791K
Mobilitycares LLC	ID	Optometrist	$0	$492.2K

Smiles 4 Kids Caldwell — Billing Profile & Reimbursement Data

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Smiles 4 Kids Caldwell — 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