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

Why is the Medicaid comparison limited to South 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. South 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.

Black Hills Pediatric Dentistry (NPI 1194867499)

Field	Value
Entity Type	Organization
Organization	Black Hills Pediatric Dentistry
Address	700 Sheridan Lake Rd
City	Rapid City
State	SD
ZIP	57702
Taxonomy	Pediatric Dentistry
NPI Enumerated	February 13, 2007

Payer Source	Total Paid
Medicaid	$24.7M
Medicare	$0

Key Findings

BLACK HILLS PEDIATRIC DENTISTRY is effectively a Medicaid-focused practice with no Medicare billing on file and $24.7M in lifetime Medicaid revenue; the absence of Medicare activity indicates its revenue stream and clinical volume are driven almost entirely by pediatric Medicaid beneficiaries rather than fee-for-service Medicare patients. The NPI was enumerated 2007-02-13 (~19 years ago), indicating long tenure in the market and an established presence in Rapid City, SD.

Revenue concentration is high: the precomputed top three Medicaid codes (D2930, D7140, D2391) account for 44.7% of this provider's total Medicaid revenue. Those three codes individually generate $6.9M (28.3%), $2.2M (9.0%), and $1.8M (7.4%) respectively, signaling reliance on a narrow set of services for nearly half of Medicaid revenue.

The service mix is consistent with a high-volume pediatric dentistry operation: preventive and routine pediatric procedures dominate the code set (for example, D1208 – Topical application of fluoride with 56K claims and $1.4M revenue, D1120 – Prophylaxis–child with 34.7K claims and $1.4M revenue, and D1351 – Sealant – per tooth with 39.3K claims and $1.3M revenue). At the same time, restorative and operative codes such as D2391 and D2392 (posterior resin-based composites) and D2330 (anterior composite) appear prominently, and the high-volume extraction code D7140 (23.5K claims, $2.2M) indicates substantial treatment of decay or extractions in the patient population.

Competitive standing within South Dakota is dominant on many codes: the practice ranks #1 statewide for multiple high-revenue codes including D2930 (100th percentile), D7140 (100th percentile, labeled an extreme outlier), D2391 (100th percentile, extreme outlier), D1208 (100th percentile, extreme outlier), and several radiography and restorative codes. Those #1 rankings and repeated 100th- and 99th-percentile placements indicate this provider is a major statewide volume leader for pediatric dental services billed to Medicaid.

Several codes are characterized as extreme outliers or notably above typical state volume, highlighting unusual concentration relative to peers: D7140 and D2391 are called out as extreme outliers, while D2930 and D9420 are described as notably above typical state volume. This pattern suggests the practice delivers both preventative and higher-acuity interventions at volumes well above typical in-state peers, not merely routine preventive visits.

Operational implications: the combination of very high claim counts for preventive codes (e.g., D1208 56K claims, D0120 42.7K claims, D0230 42.2K claims) together with high-volume restorative and extraction codes implies a practice structured for high throughput—likely multiple operatories and scheduling focused on serving a large pediatric Medicaid population. The mix suggests parallel workflows for preventive care (sealants, fluoride, prophylaxis) and same-day or rapid restorative/extraction care.

Revenue risk and resilience: dependence on a small set of codes for 44.7% of Medicaid revenue concentrates financial exposure to reimbursement or policy changes affecting those services. While the large preventive portfolio (sealants, fluoride, prophylaxis) may provide stable patient flow, the high share from a few restorative/extraction codes increases sensitivity to state fee-schedule adjustments or prior-authorization changes.

Coding and utilization nuance: many high-volume codes are also high-ranking statewide (for example, D0120 is #2 of 176 providers at the 99th percentile and D1120 is #2 of 141 providers at the 99th percentile), indicating the provider’s utilization pattern is unusually heavy across both diagnostic/evaluation and prophylactic service lines relative to peers. A reviewer should interpret these consistent top-percentile positions as evidence of market leadership in pediatric Medicaid dental utilization rather than isolated spikes in single procedure types.

Medicaid: Complete Services Breakdown

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

41 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D2930	N/A	37,290	$180	$6.9M
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	23,490	$90	$2.2M
D2391	Resin‑based composite – one surface, posterior	20,040	$90	$1.8M
D1120	Prophylaxis–child	34,720	$40	$1.4M
D1208	Topical application of fluoride - excluding varnish	56,030	$30	$1.4M
D0120	Periodic oral evaluation - established patient	42,700	$30	$1.4M
D1351	Sealant - per tooth	39,310	$30	$1.3M
D9420	N/A	7,110	$170	$1.2M
D3220	N/A	7,610	$100	$791.1K
D2392	Post 2 surface resin‑based composite	6,000	$120	$707.8K

Showing 1–10 of 41

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Black Hills Pediatric Dentistry — 20 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

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

41 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D2930	N/A	1	10	230	$180	$1.3M
D2390	N/A	2	10	2,130	$200	$420.9K
D9420	N/A	1	10	640	$160	$317.3K
D3220	N/A	2	10	720	$100	$297.4K
D1510	N/A	2	10	890	$180	$161.4K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	1	40	260	$90	$151.5K
D1351	Sealant - per tooth	2	50	400	$30	$117.3K
D2391	Resin‑based composite – one surface, posterior	1	40	150	$80	$115.5K
D2140	Amalgam - one surface, primary or permanent	1	10	40	$80	$111.6K
D2330	Resin-based composite - one surface, anterior	1	10	500	$90	$101.9K

Showing 1–10 of 41

Nearby Providers

Other providers in the same ZIP code as Black Hills Pediatric Dentistry, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Black Hills Works Inc	SD	Developmentally Disabled Services Day Training Agency	$0	$149.7M
Great Plains Tribal Chairmen's Health Board	SD	Pharmacy	$0	$36.4M
Dakota Dental 4 Kids	SD	Dental Clinic/Center	$0	$7.1M
Oglala Sioux Tribe	SD	Obstetrics & Gynecology Physician	$0	$5.2M
Rushmore Ambulatory Surgery Center	SD	Ambulatory Surgical Clinic/Center	$0	$4.6M
Stay Graceful Inc	SD	In Home Supportive Care Agency	$0	$3.4M
Children's Care Hospital And School	SD	Rehabilitation Clinic/Center	$0	$2.1M
Rushmore Dental Products, Inc.	SD	Durable Medical Equipment & Medical Supplies	$0	$1.7M
Black Hills Orthopedic & Spine Center, Inc.	SD	Multi-Specialty Clinic/Center	$0	$1.7M
Black Hills Caregiving, LLC	SD	Home Health Agency	$0	$1.1M

Black Hills Pediatric Dentistry — Billing Profile & Reimbursement Data

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Black Hills Pediatric Dentistry — 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