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

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

Smiles 4 Kids PC (NPI 1487902581)

Field	Value
Entity Type	Organization
Organization	Smiles 4 Kids PC
Address	7631 Cass Street
City	Omaha
State	NE
ZIP	68114
Taxonomy	General Practice Dentistry
NPI Enumerated	August 21, 2012

Payer Source	Total Paid
Medicaid	$11.5M
Medicare	$0

Key Findings

This provider is effectively a Medicaid-focused dental practice: lifetime Medicaid revenue is $11.5M and there is no Medicare billing on file, indicating a single-payer footprint in the available data. The top 3 Medicaid codes by revenue account for 47.3% of the provider’s Medicaid revenue, underscoring concentrated reliance on a small set of procedures.

The procedure mix is strongly preventive and pediatric-oriented. High-volume codes include D1351 (sealant) with 81.7K claims and $2.1M revenue, D1206 (topical fluoride) with 71K claims and $1.7M revenue, and D1120 (prophylaxis–child) with 57.3K claims and $1.6M revenue, together signaling a clinic model focused on routine pediatric preventive services.

Revenue concentration is pronounced: D1351 alone represents $2.1M (18.5% of Medicaid revenue), and the top three codes (D1351, D1206, D1120) together make up 47.3% of Medicaid revenue. That level of concentration implies that shifts in reimbursement or utilization for these specific codes would materially affect overall revenue.

Competitive standing within Nebraska is dominant on multiple preventive codes. The provider ranks #1 of 129 for D1351 (100th percentile; extreme outlier) and shows top-tier ranks for D1206 (#2 of 317, 100th percentile; extreme outlier) and D1120 (#2 of 289, 100th percentile; extreme outlier), indicating it is a major statewide player for pediatric preventive dentistry.

Claim volumes point to very high throughput: 81.7K claims for D1351, 71K claims for D1206, and 57.3K claims for D1120, which together reflect sustained, repeated delivery of preventive services rather than sporadic high-dollar interventions. Such volumes are consistent with a high-volume clinic or clinics serving a large pediatric Medicaid population.

The provider also bills materially for diagnostic and restorative services, not just prevention. Notable entries include D0120 with 55.4K claims and $1.3M revenue (11.6% of Medicaid revenue), D2392 with $603.9K revenue (ranks #2 of 144, 99th percentile; extreme outlier), and D0230 with 67.1K claims and $335.7K revenue (ranks #1 of 141, 100th percentile; extreme outlier), indicating an integrated service mix of exams, radiographs, and posterior composite restorations.

Several high-volume codes beyond the top three also appear as extreme outliers statewide, including D1110 (12.6K claims, $452K, #1 of 308, 100th percentile) and D0220 (39K claims, $273.2K, #1 of 213, 100th percentile), reinforcing the provider’s unusual scale relative to in-state peers across both preventive and diagnostic categories. This pattern supports characterization as a sustained, high-capacity Medicaid dental provider.

The NPI has been enumerated since 2012-08-21 (~14 years ago), providing a multi-year operational track record that coincides with $11.5M in Medicaid billings; however, the business remains concentrated in a few high-volume pediatric/preventive codes (top 3 = 47.3%), which represents a strategic concentration risk if Medicaid policy or utilization patterns change for those services.

Medicaid: Complete Services Breakdown

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

31 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D1351	Sealant - per tooth	81,700	$30	$2.1M
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	70,990	$20	$1.7M
D1120	Prophylaxis–child	57,280	$30	$1.6M
D0120	Periodic oral evaluation - established patient	55,430	$20	$1.3M
D2930	N/A	6,680	$120	$801.1K
D2392	Post 2 surface resin‑based composite	7,460	$80	$603.9K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	12,560	$40	$452K
D0230	Intraoral - periapical each additional radiographic image	67,150	$10	$335.7K
D9230	N/A	11,500	$30	$333.6K
D1999	N/A	31,000	$10	$310K

Showing 1–10 of 31

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nebraska Distribution

Smiles 4 Kids PC — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nebraska

Full comparison — all codes billed, vs. Nebraska median

31 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D2930	N/A	7	50	540	$120	$269K
D1351	Sealant - per tooth	1	130	460	$30	$84.7K
D2392	Post 2 surface resin‑based composite	2	140	270	$80	$66.8K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	2	320	460	$20	$62.2K
D1120	Prophylaxis–child	2	290	320	$30	$61K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	18	100	180	$60	$58.2K
D0120	Periodic oral evaluation - established patient	2	400	430	$20	$44.3K
D0145	N/A	2	50	80	$40	$36.5K
D9420	N/A	8	30	190	$80	$35.9K
D2391	Resin‑based composite – one surface, posterior	1	120	150	$60	$33.1K

Showing 1–10 of 31

Nearby Providers

Other providers in the same ZIP code as Smiles 4 Kids PC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital & Medical Center	NE	Children's Hospital	$0	$89.8M
Children's Physicians	NE	Pediatrics Physician	$0	$39.4M
Nebraska Pediatric Practice, Inc	NE	Pediatrics Physician	$0	$29M
Physicians Clinic Inc	NE	Family Medicine Physician	$0	$20.5M
Nebraska Methodist Hospital	NE	General Acute Care Hospital	$0	$14.5M
Children's Hospital	NE	Pediatric Emergency Medicine (Pediatrics) Physician	$0	$8.4M
Nebraska Methodist Hospital	NE	Emergency Medicine Physician	$0	$5.3M
Unmc College Of Dentistry	NE	Dentist	$0	$4.8M
Stones Worth Stepping, P.C.	NE	Occupational Therapist	$0	$4.7M
Pacific Surgery Center, LLC	NE	Ambulatory Surgical Clinic/Center	$3.4M	$3.2K

Smiles 4 Kids PC — Billing Profile & Reimbursement Data

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Smiles 4 Kids PC — 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