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 Armed Forces Americas for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Armed Forces Americas 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. Armed Forces Americas (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.

Seth Monson (NPI 1649646258)

Field	Value
Entity Type	Individual
Organization	Seth Monson
Address	2103 North Division St
City	Apo
State	AA (Armed Forces Americas)
ZIP	98433
Taxonomy	Dentist
NPI Enumerated	August 18, 2015

Payer Source	Total Paid
Medicaid	$7.5K
Medicare	$0

Key Findings

SETH MONSON has no Medicare billing on file and a very small Medicaid footprint totaling $7.5K in lifetime Medicaid revenue, effectively making this an exclusively Medicaid-billed practice in the available records. This means payer mix is single-payer in the dataset rather than a split between Medicare and Medicaid.

The provider’s NPI was enumerated on 2015-08-18 (~11 years ago), indicating roughly a decade of enrollment in federal provider databases; despite this tenure, the billing footprint in the claims dataset remains small in dollar terms.

Revenue is highly concentrated: the top three Medicaid codes account for 100.0% of this provider’s Medicaid revenue, with D0120 representing 57.4%, D1120 representing 33.0%, and D1208 representing 9.6% of the total. This concentration indicates almost all reported Medicaid payments are tied to a narrow set of services.

The code mix — D0120 (Periodic oral evaluation - established patient), D1120 (Prophylaxis–child), and D1208 (Topical application of fluoride - excluding varnish) — points to a preventive, largely pediatric and routine-care orientation rather than a restorative or surgical dental practice. Claim counts (160 for D0120, 62 for D1120, 38 for D1208) reinforce that the practice’s Medicaid activity is driven by routine visits and preventive procedures.

For competitive standing within the state, the provider ranks #1 of 2 for both D0120 and D1120 at the 100th percentile, yet both codes are characterized in the data as "typical, unremarkable volume for this code." This combination suggests the top ranking reflects a very small in-state provider pool rather than unusually high volumes in absolute terms.

D1208 is ranked #2 of 2 (0th percentile) and is also labeled "typical, unremarkable volume for this code," contributing $722 (9.6% of Medicaid revenue). Its lower rank and smaller revenue share show it is a secondary component of the provider’s Medicaid billing profile.

Average paid-per-claim values are modest and consistent with preventive dentistry: $27 avg paid/claim for D0120, $40 for D1120, and $19 for D1208. Those low per-claim reimbursements, combined with the small total revenue, indicate limited Medicaid reimbursement scale rather than high-value procedures.

Operationally, the narrow range of billed codes and low aggregate Medicaid revenue imply the provider either sees a limited number of Medicaid patients or bills Medicaid primarily for routine preventive services; this pattern may be relevant for network adequacy reviews or targeted outreach by payers seeking preventive pediatric capacity.

Medicaid: Complete Services Breakdown

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

3 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D0120	Periodic oral evaluation - established patient	160	$30	$4.3K
D1120	Prophylaxis–child	60	$40	$2.5K
D1208	Topical application of fluoride - excluding varnish	40	$20	$720

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Armed Forces Americas providers billing the same CPT/HCPCS codes. Note: "AA" is a US military postal designation for Armed Forces stationed in the Americas (outside the US and Canada) — not a traditional US state; claims coded under it are benchmarked here as their own state-equivalent group.

Claims Volume vs. Armed Forces Americas Distribution

Seth Monson — 1 of 3 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Armed Forces Americas

Full comparison — all codes billed, vs. Armed Forces Americas median

3 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D0120	Periodic oral evaluation - established patient	1	10	150	$20	$3.4K
D1120	Prophylaxis–child	1	10	60	$40	$2.3K
D1208	Topical application of fluoride - excluding varnish	2	10	50	$20	$680

Nearby Providers

Other providers in the same ZIP code as Seth Monson, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Amanda Baskerville	WA	Audiologist	$11.4K	$0

Seth Monson — Billing Profile & Reimbursement Data

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Seth Monson — 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