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

Why is the Medicaid comparison limited to Idaho 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. Idaho (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 (NPI 1538563044)

Field	Value
Entity Type	Organization
Organization	Smiles 4 Kids
Address	5737 W Fairview Ave
City	Boise
State	ID
ZIP	83706
Taxonomy	Dentist
NPI Enumerated	October 13, 2014

Payer Source	Total Paid
Medicaid	$9.6M
Medicare	$0

Key Findings

This provider is effectively a Medicaid-focused practice: there is no Medicare billing on file while the provider reported $9.6M in Medicaid revenue. The absence of any Medicare activity makes payer mix heavily concentrated toward Medicaid-covered services and reimbursement rules.

Revenue is highly concentrated in a few preventive and diagnostic codes: the top three Medicaid codes (D1120, D1110, D2930) account for 57.2% of total Medicaid revenue. D1120 alone generated $2.5M (26.1% of Medicaid revenue), D1110 generated $1.9M (19.5%), and D2930 generated $1.1M (11.6%), indicating most dollars flow from a small set of service types.

The code mix points to a high-volume prophylaxis-focused operation serving both children and adults: D1120 (Prophylaxis–child) and D1110 (Prophylaxis - adult) together represent a large share of revenue and claim volume. Significant revenue from D0210 (Intraoral - complete series of radiographic images, $1M, 10.5%) and other diagnostic codes suggests routine preventive visits are paired with full-series radiographs and diagnostic workups.

SMILES 4 KIDS is a dominant statewide competitor for multiple codes: D1110 ranks #1 of 318 providers in-state (100th percentile; extreme outlier), D2930 ranks #1 of 54 providers (100th percentile; extreme outlier), and D1120 ranks #3 of 247 providers (99th percentile; extreme outlier). These top-percentile rankings indicate the practice operates at volumes far above typical state providers for its highest-revenue services.

There are several unusual claim patterns that merit attention for contract design or audit planning: D1206 and D0230 show extremely high claim counts (48.8K and 48.7K claims respectively) with $0 average paid/claim, and D1351 shows 86.9K claims at $1 avg paid/claim; all three rank #1 in-state (100th percentile) and are described as extreme outliers for claim volume. These entries look like billing or reimbursement anomalies or program-specific reporting patterns that materially affect observed utilization but generate limited paid revenue.

Beyond the top three, the practice reports high relative volume in additional diagnostic and preventive codes: D0210 produced $1M (10.5% of Medicaid revenue) and D0330 and D0274 are both ranked #1 in-state (100th percentile; extreme outlier for those codes), reinforcing a pattern of concentrated diagnostic and preventive service provision. This suggests operational focus on high-throughput, clinic-style delivery rather than a services mix weighted toward complex restorative or specialty care.

Although much revenue concentrates in a few codes, the practice also bills a range of restorative and surgical codes at notable volumes: examples include D2934 ($121.7K, ranks #3 of 12), D7140 ($97.4K, ranks #19 of 107), and multiple amalgam and composite codes in above-typical percentiles (e.g., D2150 ranks #1 of 15, D2392 ranks #27 of 193). This indicates the operation performs a meaningful volume of restorative and extraction services in addition to heavy preventive throughput.

The provider has been enumerated for a substantial period, listed as NPI enumerated 2014-10-13 (~12 years ago), which supports interpretation of the observed high-volume patterns as an established business model rather than a recent anomaly. Given the combination of long tenure, extreme in-state rankings, and concentrated Medicaid revenue of $9.6M, payers and provider network analysts should consider this entity a major Medicaid service provider in Idaho for prophylaxis and routine diagnostics.

Medicaid: Complete Services Breakdown

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

32 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D1120	Prophylaxis–child	34,700	$70	$2.5M
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	19,660	$100	$1.9M
D2930	N/A	15,010	$70	$1.1M
D0210	Intraoral - complete series of radiographic images	4,320	$230	$1M
D0330	N/A	9,340	$90	$793.7K
D0274	N/A	19,740	$30	$533K
D9420	N/A	1,270	$270	$342.4K
D0150	Comprehensive oral evaluation – new or established patient	5,990	$50	$287.4K
D2392	Post 2 surface resin‑based composite	2,560	$90	$217.9K
D0145	N/A	3,480	$60	$194.7K

Showing 1–10 of 32

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Smiles 4 Kids — 10 of 23 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

32 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D2930	N/A	1	50	750	$70	$171.2K
D1120	Prophylaxis–child	3	250	180	$60	$143K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	1	320	310	$80	$80.8K
D9420	N/A	8	40	180	$150	$80.8K
D2392	Post 2 surface resin‑based composite	27	190	280	$60	$72.9K
D2934	N/A	3	10	190	$280	$70.8K
D0210	Intraoral - complete series of radiographic images	2	120	140	$120	$66K
D0145	N/A	4	30	370	$50	$44K
D2393	Resin-based composite, three surfaces, posterior	13	70	140	$120	$41.6K
D0330	N/A	1	170	170	$50	$35.6K

Showing 1–10 of 32

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Safeway Inc	ID	Community/Retail Pharmacy	$76.1M	$330
Albertsons LLC	ID	Community/Retail Pharmacy	$29M	$0
American Drug Stores LLC	ID	Community/Retail Pharmacy	$27.3M	$0
Vons Companies Inc	ID	Community/Retail Pharmacy	$12.7M	$0
Nai Saturn Eastern LLC	ID	Community/Retail Pharmacy	$12.6M	$0
Acme Markets Inc	ID	Community/Retail Pharmacy	$9.5M	$0
Randalls Food & Drugs LP	ID	Community/Retail Pharmacy	$6.7M	$0
Shaws Supermarkets Inc	ID	Community/Retail Pharmacy	$5.5M	$0
Saint Alphonsus Regional Medical Center Inc	ID	General Acute Care Hospital	$0	$5.1M
Tdandc LLC	ID	Home Health Agency	$0	$4.9M

Smiles 4 Kids — Billing Profile & Reimbursement Data

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Smiles 4 Kids — 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