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.

Roberts, Wallace & Associates PLLC (NPI 1578054557)

Field	Value
Entity Type	Organization
Organization	Roberts, Wallace & Associates PLLC
Address	2643 Randleman Rd
City	Greensboro
State	NC
ZIP	27406
Taxonomy	General Practice Dentistry
NPI Enumerated	May 24, 2018

Payer Source	Total Paid
Medicaid	$42.4M
Medicare	$0

Key Findings

This entity is effectively a Medicaid-centric dental provider: lifetime Medicaid revenue on file is $42.4M and there is no Medicare billing on file, so analyses should treat Medicaid as the sole payer channel for this NPI. The practice has an established NPI (enumerated 2018-05-24, ~8 years ago), giving several years of observable billing patterns to evaluate.

Revenue is highly concentrated in a small set of dental procedure codes: the top three Medicaid codes (D2930, D1120, D0120) together account for 33.6% of the provider's total Medicaid revenue. Those three codes individually contribute $6M (14.2%) for D2930, $4.5M (10.8%) for D1120, and $3.6M (8.6%) for D0120, indicating a meaningful reliance on a narrowly defined set of services.

The code mix points to a high-volume preventive and diagnostic pediatric focus. Large claim volumes and revenues for preventive pediatric codes — D1120 with 166.8K claims and $4.5M revenue, D1206 with 198.3K claims and $3.2M revenue, and D1351 with 116.3K claims and $3M revenue — suggest routine prophylaxis, topical fluoride, and sealant services are core to the operation’s service line.

Diagnostic and exam activity is also a dominant component of the billing profile: D0230 shows 187.8K claims and $2.1M revenue, D0220 has 121.3K claims and $1.7M revenue, and D0150 reports 40.3K claims and $1.7M revenue. Each of these codes ranks at the 100th percentile statewide (extreme outlier), which reinforces that imaging and evaluations are a persistent, high-volume part of this provider’s workflow.

Restorative and surgical services are significant secondary revenue drivers. D2392 (post 2 surface resin-based composite) generates $3.6M with 35.8K claims and D7140 (extraction) contributes $1M with 17.4K claims, indicating that beyond preventive care the practice delivers substantial restorative and extraction procedures to its Medicaid population.

Across multiple codes this provider is a statewide outlier and in many cases the top-ranked biller: examples include D2930 (#1 of 258, 100th percentile; extreme outlier), D1120 (#1 of 1135, 100th percentile; extreme outlier), and D0120 (#1 of 1438, 100th percentile; extreme outlier). This pattern characterizes the provider as a dominant presence in North Carolina Medicaid for several preventive and diagnostic dental codes rather than a modest participant.

Operational scale is very large relative to peers, as shown by unusually high claim counts for single codes (e.g., D1206 198.3K claims, D0230 187.8K claims, D1120 166.8K claims). Such throughput is consistent with a high-volume clinic model or programmatic service delivery (for example extensive school-based or community preventive programs), and should be considered when comparing cost, utilization, and contract negotiations.

Given the extreme outlier status reported across many procedures, the provider’s billing profile warrants targeted benchmarking and operational review to understand patient mix, site(s) of service, and contractual arrangements. The data-driven labels ("extreme outlier", "notably above typical") used in statewide rankings indicate this provider’s pattern is materially different from typical in-state peers and is a clear signal for deeper competitive and programmatic analysis.

Medicaid: Complete Services Breakdown

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

42 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D2930	N/A	46,490	$130	$6M
D1120	Prophylaxis–child	166,770	$30	$4.5M
D0120	Periodic oral evaluation - established patient	144,040	$30	$3.6M
D2392	Post 2 surface resin‑based composite	35,790	$100	$3.6M
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	198,260	$20	$3.2M
D1351	Sealant - per tooth	116,290	$30	$3M
D0230	Intraoral - periapical each additional radiographic image	187,820	$10	$2.1M
D9230	N/A	47,390	$40	$2M
D0220	Intraoral - periapical first radiographic image	121,280	$10	$1.7M
D0150	Comprehensive oral evaluation – new or established patient	40,280	$40	$1.7M

Showing 1–10 of 42

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

Roberts, Wallace & Associates PLLC — 21 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

42 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D2930	N/A	1	260	710	$140	$426.8K
D9223	N/A	6	100	1,240	$140	$396K
D2392	Post 2 surface resin‑based composite	3	940	660	$100	$205.2K
D9222	N/A	26	90	750	$80	$187.1K
D9230	N/A	1	460	800	$40	$127.7K
D0120	Periodic oral evaluation - established patient	1	1,440	1,210	$30	$116.6K
D1120	Prophylaxis–child	1	1,140	780	$30	$116.3K
D2391	Resin‑based composite – one surface, posterior	12	790	410	$80	$114.6K
D1351	Sealant - per tooth	1	540	980	$30	$114.4K
D2934	N/A	21	40	230	$160	$112.8K

Showing 1–10 of 42

Related Providers

Other providers that share a Tax Identification Number (TIN) with Roberts, Wallace & Associates PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sat Pyol Lee	IL	General Practice Dentistry	$0	$2.8M

Nearby Providers

Other providers in the same ZIP code as Roberts, Wallace & Associates PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Alberta Professional Services	NC	Respite Care	$0	$57.9M
Roberts & Associates - Greensboro PLLC	NC	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$10.8M
Quality Care Iii , LLC	NC	Community/Behavioral Health Agency	$0	$8.7M
Richard Evans	NC	Surgery Physician	$63.1K	$0

Roberts, Wallace & Associates PLLC — Billing Profile & Reimbursement Data

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Roberts, Wallace & Associates PLLC — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References