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

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

Rafael Rivera, Jr., Dds, PLLC (NPI 1528237435)

Field	Value
Entity Type	Organization
Organization	Rafael Rivera, Jr., Dds, PLLC
Address	3053 Freedom Dr Ste B
City	Charlotte
State	NC
ZIP	28208
Taxonomy	Dentist
NPI Enumerated	February 25, 2008

Payer Source	Total Paid
Medicaid	$14M
Medicare	$0

Medicaid: Complete Services Breakdown

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

35 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D0120	Periodic oral evaluation - established patient	64,810	$30	$1.7M
D1120	Prophylaxis–child	49,970	$30	$1.3M
D2930	N/A	9,050	$140	$1.3M
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	61,480	$20	$983.6K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	24,470	$40	$929.9K
D9230	N/A	20,350	$40	$895.5K
D2392	Post 2 surface resin‑based composite	8,010	$100	$817K
D1351	Sealant - per tooth	28,680	$30	$802.9K
D2391	Resin‑based composite – one surface, posterior	9,680	$80	$735.3K
D0220	Intraoral - periapical first radiographic image	46,050	$20	$690.8K

Showing 1–10 of 35

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Rafael Rivera, Jr., Dds, PLLC — 14 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

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

35 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D2930	N/A	23	260	710	$140	$426.8K
D2392	Post 2 surface resin‑based composite	52	940	660	$100	$205.2K
D2140	Amalgam - one surface, primary or permanent	7	60	70	$70	$130.4K
D9230	N/A	11	460	800	$40	$127.7K
D0120	Periodic oral evaluation - established patient	14	1,440	1,210	$30	$116.6K
D1120	Prophylaxis–child	18	1,140	780	$30	$116.3K
D2391	Resin‑based composite – one surface, posterior	24	790	410	$80	$114.6K
D1351	Sealant - per tooth	17	540	980	$30	$114.4K
D2150	Amalgam - two surfaces, primary or permanent	7	80	220	$90	$104.7K
D2393	Resin-based composite, three surfaces, posterior	77	530	200	$120	$91.8K

Showing 1–10 of 35

Related Providers

Other providers that share a Tax Identification Number (TIN) with Rafael Rivera, Jr., Dds, PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rafael Rivera, Jr., Dds, PLLC	NC	Dentist	$0	$22.1M
Rafael Rivera, Jr., Dds, PLLC	NC	Dentist	$0	$19.1M
Rafael Rivera, Jr., Dds, PLLC	NC	Dentist	$0	$17.8M
Rafael Rivera, Jr., Dds, PLLC	NC	Dentist	$0	$16.4M
Rafael Rivera, Jr, Dds, PLLC	NC	Dentist	$0	$14.8M
Rafael Rivera, Jr., Dds, PLLC	NC	Dentist	$0	$14.2M
Rafael Rivera, Jr, Dds, PLLC	NC	Dentist	$0	$8.6M

Nearby Providers

Other providers in the same ZIP code as Rafael Rivera, Jr., Dds, PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mission Medstaff, LLC	NC	Nursing Care Agency	$0	$59.6M
Mecklenburg Emergency Medical Services Agency	NC	Land Ambulance	$6.7M	$33.7M
S.t.e.p's Developmental Academy, Inc.	NC	Community/Behavioral Health Agency	$0	$25M
Mm Home Care, LLC	NC	In Home Supportive Care Agency	$0	$12.4M
Mecklenburg County	NC	Public Health or Welfare Agency	$0	$10.2M
Blake Home Health Care LLC	NC	In Home Supportive Care Agency	$0	$9M
National Seating & Mobility, Inc.	NC	Durable Medical Equipment & Medical Supplies	$0	$7.6M
Metrolina Vascular Access Care LLC	NC	Ambulatory Surgical Clinic/Center	$2.1M	$434.7K
Adit Mahale	NC	Nephrology Physician	$197.1K	$0
Chris Fotiadis	NC	Nephrology Physician	$187.9K	$0

Rafael Rivera, Jr., Dds, PLLC — Billing Profile & Reimbursement Data

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Rafael Rivera, Jr., Dds, PLLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References