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

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

David Congalton (NPI 1407847916)

Field	Value
Entity Type	Individual
Organization	David Congalton
Address	106 Main St
City	Vergennes
State	VT
ZIP	05491
Taxonomy	Dentist
NPI Enumerated	November 3, 2005

Payer Source	Total Paid
Medicaid	$177.4K
Medicare	$0

Medicaid: Complete Services Breakdown

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

6 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	1,540	$50	$75.7K
D0120	Periodic oral evaluation - established patient	2,190	$30	$57K
D0274	N/A	590	$30	$18.2K
D1208	Topical application of fluoride - excluding varnish	1,010	$20	$18.1K
D1120	Prophylaxis–child	270	$30	$8.4K
0120	N/A	20	$0	$0

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Vermont Distribution

David Congalton — 0 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. Vermont median

6 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	39	150	540	$50	$73.5K
D1120	Prophylaxis–child	51	110	220	$40	$59.2K
D0120	Periodic oral evaluation - established patient	35	160	720	$30	$57.8K
D0274	N/A	39	100	250	$30	$31.1K
D1208	Topical application of fluoride - excluding varnish	7	40	180	$20	$14K
0120	N/A	1	10	20	$0	$0

Nearby Providers

Other providers in the same ZIP code as David Congalton, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Vergennes Area Rescue Squad Inc.	VT	Ambulance	$111.1K	$244.8K
Daniel Huber	VT	Family Medicine Physician	$92.2K	$0
Specialeyes Professional Eye Care Services, PLLC	VT	Optometrist	$0	$87.1K
Kph Healthcare Services, Inc.	VT	Community/Retail Pharmacy	$74.7K	$0
Amanda Dingman-parini	VT	Clinical Psychologist	$0	$64.3K
Dylan Estes	VT	Family Medicine Physician	$44K	$0
Karen Fromhold	VT	General Practice Physician	$36.7K	$0
Joel Palmer	VT	Chiropractor	$27.2K	$0
Shauna Mckeon	VT	Adult Health Nurse Practitioner	$23K	$0

David Congalton — Billing Profile & Reimbursement Data

Sign up for David Congalton — Billing Profile & Reimbursement Data policy alerts

David Congalton — Billing Profile & Reimbursement Data

Sign up for David Congalton — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References