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

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

State Of Utah, Department Of Health (NPI 1437252491)

Field	Value
Entity Type	Organization
Organization	State Of Utah, Department Of Health
Address	Salt Lake Clinic - Family Dental Plan
City	Salt Lake City
State	UT
ZIP	84114
Taxonomy	General Practice Dentistry
NPI Enumerated	September 6, 2006

Payer Source	Total Paid
Medicaid	$1.3M
Medicare	$0

Medicaid: Complete Services Breakdown

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

26 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	4,980	$50	$229.3K
D0140	Limited oral evaluation – problem focused	2,200	$90	$204.6K
D5110	N/A	190	$1,010	$191.1K
D0150	Comprehensive oral evaluation – new or established patient	1,240	$120	$142K
D0120	Periodic oral evaluation - established patient	1,260	$90	$113K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	1,220	$60	$68.3K
D2150	Amalgam - two surfaces, primary or permanent	1,100	$50	$55.9K
D0230	Intraoral - periapical each additional radiographic image	13,130	$1	$52.5K
D0220	Intraoral - periapical first radiographic image	4,710	$10	$37.7K
D2140	Amalgam - one surface, primary or permanent	850	$40	$33.1K

Showing 1–10 of 26

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Utah Distribution

State Of Utah, Department Of Health — 3 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. Utah median

26 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D5110	N/A	2	10	190	$890	$238.8K
D0120	Periodic oral evaluation - established patient	147	470	460	$80	$149.8K
D5120	N/A	2	10	160	$580	$98.6K
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…	21	40	260	$80	$66.8K
D1351	Sealant - per tooth	77	190	620	$30	$60.7K
D0140	Limited oral evaluation – problem focused	11	260	140	$120	$55.8K
D2150	Amalgam - two surfaces, primary or permanent	47	220	290	$60	$45K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	3	150	170	$60	$35.9K
D4355	N/A	4	10	80	$130	$34.5K
D0220	Intraoral - periapical first radiographic image	32	440	470	$20	$32.8K

Showing 1–10 of 26

State Of Utah, Department Of Health — Billing Profile & Reimbursement Data

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State Of Utah, Department Of Health — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Frequently Asked Questions

References