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

Why is the Medicaid comparison limited to North Dakota 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. North Dakota (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.

Doughboy Pediatric Dental Group (NPI 1184197931)

Field	Value
Entity Type	Organization
Organization	Doughboy Pediatric Dental Group
Address	2615 Elk Dr Ste 1
City	Minot
State	ND
ZIP	58701
Taxonomy	Pediatric Dentistry
NPI Enumerated	January 4, 2019

Payer Source	Total Paid
Medicaid	$5.6M
Medicare	$0

Key Findings

DOUGHBOY PEDIATRIC DENTAL GROUP is effectively a single‑payer Medicaid provider with $5.6M in lifetime Medicaid revenue and no Medicare billing on file; the absence of Medicare activity means analyses should treat Medicaid as the primary commercial exposure and revenue driver. This payer concentration suggests financial and operational sensitivity to Medicaid policy and reimbursement changes.

Revenue is highly concentrated in a small set of pediatric dental services: D2930, D1120, and D1351 together account for 46.5% of the provider's total Medicaid revenue, with D2930 generating $1.3M (22.7%), D1120 $769.3K (13.8%), and D1351 $557.8K (10.0%). This level of concentration indicates that a few procedure lines drive nearly half of all Medicaid payments to the group.

The code mix and descriptions point to a high‑volume pediatric preventive and routine restorative practice: D1120 (Prophylaxis–child), D1351 (Sealant - per tooth), D1208 (Topical application of fluoride) and high counts for periodic evaluations (D0120) all appear near the top of billing by claims and revenue. High claim counts such as 19.7K claims for D1120 and 18.6K claims for D1351 emphasize operational throughput focused on preventive pediatric dentistry rather than specialist or complex adult care.

State competitive standing is dominant for several core pediatric codes: the practice ranks #1 of 79 providers in‑state for D1120 (100th percentile; extreme outlier) and #1 of 31 for D1351 (100th percentile; extreme outlier), and it ranks #1 of 10 for D2930 (100th percentile; notably above typical state volume). These rankings characterize the group as a major statewide provider for routine pediatric preventive services and tempered restorative items.

While preventive services dominate revenue, the provider also reports meaningful restorative and urgent care activity — for example, D2392 ($303.1K; 2.8K claims) and D7140 ($267.3K; 3.5K claims) — showing capacity for operative dentistry and extractions alongside prevention. The restorative codes generally rank in high percentiles (e.g., D2392 ranks #2 of 35, 97th percentile), indicating that restorative and extraction volumes are above typical state levels but not unusual relative to the provider’s preventive footprint.

Diagnostic and evaluation throughput is high, supporting the preventive profile: D0120 (18K claims, $541.3K, 9.7% of Medicaid revenue) and D0150 (2.3K claims, $103.4K) are both top codes, and radiographic codes such as D0272 (8.9K claims, $256.7K) and D0220 (2.7K claims, $52K) rank near the top of in‑state volumes. These volumes indicate a sustained flow of new and established pediatric visits that drive preventive and restorative encounters.

Several individual codes show distinct statistical notes worth attention: multiple top codes are labeled as "extreme outlier" or "notably above typical state volume" (for example, D1120 and D1351 are extreme outliers, D2930 is notably above typical state volume), while others are described as "typical, unremarkable volume" (e.g., D2392 for restorative work). There is also a niche code, D2932, with $15.4K revenue and $315 avg paid/claim that ranks #1 of 1 providers (0th percentile; no state peer volume comparison available), which suggests limited or unique peer reporting for that procedure in the state.

NPI tenure: the provider was enumerated on 2019-01-04 (~7 years ago), indicating a relatively recent establishment that has scaled quickly to achieve high claim counts and top statewide ranks for multiple pediatric codes. Rapid growth to top decile/state leadership in core pediatric preventive codes may reflect a concentrated operational model optimized for high Medicaid pediatric volume.

Medicaid: Complete Services Breakdown

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

23 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D2930	N/A	8,830	$140	$1.3M
D1120	Prophylaxis–child	19,730	$40	$769.3K
D1351	Sealant - per tooth	18,590	$30	$557.8K
D0120	Periodic oral evaluation - established patient	18,040	$30	$541.3K
D1208	Topical application of fluoride - excluding varnish	16,900	$30	$439.4K
D2392	Post 2 surface resin‑based composite	2,760	$110	$303.1K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	3,520	$80	$267.3K
D0272	N/A	8,850	$30	$256.7K
D0240	N/A	5,710	$30	$165.7K
D9230	N/A	4,980	$30	$159.4K

Showing 1–10 of 23

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Dakota Distribution

Doughboy Pediatric Dental Group — 13 of 23 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Dakota

Full comparison — all codes billed, vs. North Dakota median

23 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D2930	N/A	1	10	1,170	$150	$264.2K
D2392	Post 2 surface resin‑based composite	2	40	130	$110	$83.4K
D9420	N/A	2	10	120	$200	$77.6K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	2	20	300	$90	$76.2K
D2391	Resin‑based composite – one surface, posterior	5	30	100	$90	$63.3K
D1120	Prophylaxis–child	1	80	360	$40	$48.3K
D0120	Periodic oral evaluation - established patient	2	120	350	$40	$46.8K
D1351	Sealant - per tooth	1	30	470	$20	$46.6K
D0140	Limited oral evaluation – problem focused	5	40	100	$70	$44K
D3220	N/A	1	10	220	$100	$40.1K

Showing 1–10 of 23

Nearby Providers

Other providers in the same ZIP code as Doughboy Pediatric Dental Group, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Minot Vocational Adjustment Workshop	ND	Community/Behavioral Health Agency	$0	$83.6M
Rem North Dakota	ND	Community/Behavioral Health Agency	$0	$72.7M
Trinity Health	ND	Multi-Specialty Clinic/Center	$0	$18.7M
Trinity Hospitals	ND	General Acute Care Hospital	$0	$7.4M
North Central Behavioral Health Clinic	ND	Clinic/Center	$0	$7M
Minot Vocational Adjustment Workshop	ND	Community/Behavioral Health Agency	$0	$6.7M
Trinity Hospitals	ND	Land Ambulance	$0	$3.5M
Minot Vocational Adjustment Workshop	ND	Community/Behavioral Health Agency	$0	$2.1M
University Of North Dakota	ND	Family Medicine Physician	$0	$1.4M
First District Health Unit	ND	Clinic/Center	$785.3K	$403.2K

Doughboy Pediatric Dental Group — Billing Profile & Reimbursement Data

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Doughboy Pediatric Dental Group — 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