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

Why is the Medicaid comparison limited to South Carolina 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. South Carolina (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.

Kool Smiles, PC (NPI 1154415958)

Field	Value
Entity Type	Organization
Organization	Kool Smiles, PC
Address	112 Broad Street
City	Sumter
State	SC
ZIP	29150
Taxonomy	General Practice Dentistry
NPI Enumerated	October 3, 2006

Payer Source	Total Paid
Medicaid	$4.2M
Medicare	$0

Medicaid: Complete Services Breakdown

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

28 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D1120	Prophylaxis–child	13,310	$40	$465.7K
D2391	Resin‑based composite – one surface, posterior	5,420	$80	$411.9K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	7,460	$50	$373.2K
D2930	N/A	2,740	$130	$342.9K
D2392	Post 2 surface resin‑based composite	3,150	$100	$315.4K
D0120	Periodic oral evaluation - established patient	13,130	$20	$302.1K
D0150	Comprehensive oral evaluation – new or established patient	6,820	$40	$272.8K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	16,260	$20	$260.2K
D0330	N/A	4,580	$50	$228.8K
D0274	N/A	7,240	$30	$195.4K

Showing 1–10 of 28

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Carolina Distribution

Kool Smiles, PC — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Carolina

Full comparison — all codes billed, vs. South Carolina median

28 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D2930	N/A	40	130	1,060	$150	$371.1K
D7240	N/A	38	60	450	$260	$370K
D2392	Post 2 surface resin‑based composite	49	350	520	$100	$175.3K
D1120	Prophylaxis–child	41	470	600	$30	$156.7K
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation; includes related cutting of gingiva and bone, removal of tooth structure, minor smoothing of…	67	120	170	$130	$125.1K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	106	290	380	$90	$125K
D9230	N/A	159	210	1,150	$30	$115.5K
D2391	Resin‑based composite – one surface, posterior	15	300	270	$80	$110.5K
D1351	Sealant - per tooth	47	200	840	$30	$108.9K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	26	590	850	$50	$104.9K

Showing 1–10 of 28

Related Providers

Other providers that share a Tax Identification Number (TIN) with Kool Smiles, PC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kool Smiles Sc-2, PC	SC	General Practice Dentistry	$0	$28.5M
Creston Dental-1, P.C.	SC	General Practice Dentistry	$0	$14.8M
Kool Smiles, PC	SC	General Practice Dentistry	$0	$4.3M
Kool Smiles Sc-2, PC	SC	General Practice Dentistry	$0	$4.2M
Kool Smiles Sc-2, PC	SC	General Practice Dentistry	$0	$3M
Kool Smiles Sc-2, PC	SC	General Practice Dentistry	$0	$2.6M
Kool Smiles Sc-2, PC	SC	General Practice Dentistry	$0	$2M
David Ashley	AL	Oral and Maxillofacial Surgery (Dentist)	$0	$1.3M

Nearby Providers

Other providers in the same ZIP code as Kool Smiles, PC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$28.1M
Sumter Pediatrics, P.A.	SC	Pediatrics Physician	$0	$24.4M
Tandem Health Sc	SC	Federally Qualified Health Center (FQHC)	$0	$17.3M
Colonial Family Practice, LLC	SC	Family Medicine Physician	$0	$9.5M
Tandem Health Sc	SC	Federally Qualified Health Center (FQHC)	$0	$7.8M
Prisma Health Tuomey	SC	Emergency Medicine Physician	$0	$6.8M
Wesmark Dental Health Center	SC	General Practice Dentistry	$0	$6.3M
Addus Healthcare (south Carolina), Inc.	SC	In Home Supportive Care Agency	$0	$5.5M
Carolina Children's Dentistry, LLC	SC	Pediatric Dentistry	$0	$5.2M
Sumter School District	SC	Local Education Agency (LEA)	$0	$4.2M

Kool Smiles, PC — Billing Profile & Reimbursement Data

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Kool Smiles, PC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References