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

Why is the Medicaid comparison limited to Maine 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. Maine (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 For Life, PA (NPI 1619283850)

Field	Value
Entity Type	Organization
Organization	Smiles For Life, PA
Address	195 Cider Hill Rd
City	Exeter
State	ME
ZIP	04435
Taxonomy	Dental Hygienist
NPI Enumerated	August 25, 2010

Payer Source	Total Paid
Medicaid	$1.8M
Medicare	$0

Medicaid: Complete Services Breakdown

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

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D1351	Sealant - per tooth	23,950	$20	$550.7K
D1354	N/A	12,390	$30	$309.7K
D2940	N/A	6,990	$40	$293.5K
D1120	Prophylaxis–child	5,720	$40	$228.8K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	7,630	$20	$137.4K
D0190	N/A	4,040	$20	$80.8K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	1,400	$50	$71.4K
D1310	N/A	1,650	$20	$37.9K
D0191	N/A	1,460	$10	$20.4K
D1355	N/A	520	$20	$9.3K

Showing 1–10 of 12

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

Smiles For Life, PA — 3 of 12 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

12 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D1351	Sealant - per tooth	4	80	1,040	$20	$87.6K
D1120	Prophylaxis–child	15	160	500	$30	$56.2K
D2940	N/A	1	20	400	$50	$50.1K
D1354	N/A	2	50	620	$20	$43.9K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	27	160	300	$40	$34.6K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	14	190	470	$10	$31.8K
D1355	N/A	8	10	1,420	$20	$29K
D0190	N/A	7	50	480	$20	$22.8K
D1310	N/A	6	30	550	$20	$20K
D9920	N/A	4	10	40	$30	$11.8K

Showing 1–10 of 12

Smiles For Life, PA — Billing Profile & Reimbursement Data

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Smiles For Life, PA — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Frequently Asked Questions

References