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

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

Bay Pediatric & Adolescent Dentistry (NPI 1609848308)

Field	Value
Entity Type	Organization
Organization	Bay Pediatric & Adolescent Dentistry
Address	115 Lottie Ln
City	Fairhope
State	AL
ZIP	36532
Taxonomy	Pediatric Dentistry
NPI Enumerated	February 6, 2006

Payer Source	Total Paid
Medicaid	$13.8M
Medicare	$0

Key Findings

This practice is effectively a Medicaid-focused pediatric dental provider: there is no Medicare billing on file while the provider reports $13.8M in lifetime Medicaid revenue, indicating a near-exclusive reliance on Medicaid as its payer base. The absence of Medicare activity implies the practice’s patient mix and service lines are predominantly pediatric and Medicaid-enrolled populations rather than fee-for-service Medicare adults.

Revenue concentration is significant in a small set of codes: the precomputed top three Medicaid codes by revenue account for 36.4% of this provider’s total Medicaid revenue. The single largest revenue driver is D2930 ($2.4M, 17.3% of Medicaid revenue), followed by D3240 ($1.3M, 9.6%) and D2392 ($1.3M, 9.5%), so a little over one-third of all Medicaid dollars are tied to these three codes.

The code mix points to a high-volume pediatric restorative and preventive operation: the top-paid codes include restorative composites (D2392, D2391, D2393), child prophylaxis and preventive fluoride/sealant services (D1120, D1208, D1206, D1351), frequent radiographs (D0230, D0220) and extractions (D7140). Together these codes and the large claim counts (for example, D0240: 57.3K claims; D0230: 48.1K claims; D1208: 36K claims) suggest a clinic model focused on routine, high-frequency pediatric dental care and restorative procedures.

The provider is a dominant statewide performer on multiple codes: several high-volume codes rank at the top of their statewide peer pools, including D2930 (rank #1 of 118, 100th percentile; extreme outlier), D3240 (rank #1 of 5, 100th percentile; notably above typical state volume), D0230 (rank #1 of 178, 100th percentile; extreme outlier), and D0240 (rank #1 of 72, 100th percentile; extreme outlier). These top ranks indicate the practice captures an outsized share of Medicaid claims for certain services compared with other Alabama providers.

Beyond the absolute leaders, many commonly billed pediatric codes are reported at unusually high volumes relative to peers: examples include D2392 (rank #5 of 280, 99th percentile; extreme outlier), D7140 (rank #3 of 188, 99th percentile; extreme outlier), and D0120/D1120 (ranks #19/#20 of their peer groups, 97th/96th percentiles; extreme outliers). This pattern shows broad-based elevated activity across preventive, diagnostic and restorative categories rather than a single-code anomaly.

Several high-volume codes have only brief or no dataset descriptions here (for example D2930 and D3240 are listed with no description available), yet they still represent material revenue lines ($2.4M and $1.3M respectively). Analysts should treat these as priority targets for chart-level review or local code-definition checks because their combined weight materially shapes the practice’s Medicaid revenue profile.

The provider’s competitive footprint is concentrated geographically and by service line: many of the practice’s top codes are extreme statewide outliers or in the top percentiles, which signals operational scale and perhaps capacity specialization within pediatric dentistry in Fairhope, AL. Given the NPI enumeration date of ~2006-02-06 (~20 years ago), this is a long-tenured operation that has built sustained Medicaid volume over time.

Operational risk and contracting implications flow from the heavy Medicaid concentration and high code-level concentration: with $13.8M in Medicaid revenue and 36.4% of Medicaid dollars tied to three codes, any policy, fee schedule, or utilization review change affecting those codes could materially affect revenue. Payers and network managers should prioritize these codes for utilization monitoring, reimbursement benchmarking, and contract negotiations given their outsized contribution to the practice’s revenue base.

Medicaid: Complete Services Breakdown

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

29 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D2930	N/A	23,940	$100	$2.4M
D3240	N/A	8,630	$150	$1.3M
D2392	Post 2 surface resin‑based composite	16,790	$80	$1.3M
D3230	N/A	9,470	$120	$1.2M
D0240	N/A	57,290	$20	$1M
D1120	Prophylaxis–child	28,090	$30	$786.6K
D0120	Periodic oral evaluation - established patient	33,660	$20	$639.6K
D1208	Topical application of fluoride - excluding varnish	36,040	$20	$540.6K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	9,100	$50	$482.2K
D1999	N/A	24,070	$20	$481.5K

Showing 1–10 of 29

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Alabama Distribution

Bay Pediatric & Adolescent Dentistry — 17 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Alabama

Full comparison — all codes billed, vs. Alabama median

29 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D3240	N/A	1	10	1,230	$150	$383.7K
D2930	N/A	1	120	1,240	$90	$233.9K
D3230	N/A	1	10	190	$120	$218.2K
D2392	Post 2 surface resin‑based composite	5	280	520	$70	$144.9K
D1120	Prophylaxis–child	20	520	810	$30	$104.3K
D2391	Resin‑based composite – one surface, posterior	14	250	380	$60	$91.8K
D1999	N/A	14	300	1,280	$20	$81.5K
D2393	Resin-based composite, three surfaces, posterior	7	90	170	$90	$78K
D0120	Periodic oral evaluation - established patient	19	620	810	$20	$77.2K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	3	190	490	$50	$76.2K

Showing 1–10 of 29

Nearby Providers

Other providers in the same ZIP code as Bay Pediatric & Adolescent Dentistry, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Eastern Shore Children's Clinic	AL	Pediatrics Physician	$0	$7.6M
Baldwin Emergency Physicians, P.C..	AL	Emergency Medicine Physician	$0	$6.7M
Dr. Trey's Children's Dentistry	AL	Pediatric Dentistry	$0	$5.9M
Fairhope Pediatrics, Inc.	AL	Pediatrics Physician	$0	$4.1M
Comfort Care Coastal Hospice, LLC	AL	Community Based Hospice Care Agency	$0	$3.4M
Gulf Health Hospitals, Inc	AL	General Acute Care Hospital	$0	$2M
William Sullivan	AL	Rheumatology Physician	$1.6M	$0
Karl Hakmiller	AL	Cardiovascular Disease Physician	$981.1K	$0
Michael Pursley	AL	Specialist	$583.3K	$0
Craig Peterson	AL	Interventional Cardiology Physician	$515.6K	$0

Bay Pediatric & Adolescent Dentistry — Billing Profile & Reimbursement Data

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Bay Pediatric & Adolescent Dentistry — 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