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

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

Rachel Anderson (NPI 1659474229)

Field	Value
Entity Type	Individual
Organization	Rachel Anderson
Address	3d Denbn/usndc
City	Fpo
State	AP (Armed Forces Pacific)
ZIP	96604
Taxonomy	Dentist
NPI Enumerated	September 7, 2006

Payer Source	Total Paid
Medicaid	$171.3K
Medicare	$0

Key Findings

This provider’s Medicaid billing profile is concentrated in pediatric and preventive dental services: the top three Medicaid codes are D1120 ($43K, Prophylaxis–child), D0120 ($29.2K, Periodic oral evaluation - established patient) and D1206 ($20.7K, Topical Fluoride Treatment), which together account for 54.2% of the provider’s reported Medicaid revenue. The presence of other high-volume preventive codes such as D1208 and D1351 further supports a practice model focused on routine pediatric preventive care rather than specialty or complex restorative work.

Revenue concentration is pronounced at the code level: with total Medicaid revenue of $171.3K, the precomputed top-three share (54.2%) shows that a majority of Medicaid dollars come from a small set of preventive codes. This concentration implies that changes in Medicaid reimbursement or utilization for a few codes would materially affect the provider’s revenue.

This provider has no Medicare billing on file (none below) and is effectively a single-payer Medicaid biller in the available data, with $0 reported Medicare revenue versus $171.3K in Medicaid. For payer-mix analysis and contracting, treat this entity as Medicaid-focused rather than a mixed Medicare/Medicaid operator.

Competitive standing in-state is strong for core preventive codes: the provider ranks #1 in-state and at the 100th percentile for D1120, D0120, D1206 and several other routine codes, which the source describes as “typical, unremarkable volume” for some and “notably above typical state volume” for others. At the same time, restorative codes such as D2392 (rank #4 of 5, 25th percentile) indicate more modest state-level presence in restorative dentistry compared with peers.

The provider shows long tenure in the NPI registry (enumerated 2006-09-07, ~20 years ago), indicating an established practice footprint that aligns with the high cumulative Medicaid claim counts observed. Long standing in the market makes the high-volume preventive pattern likely to reflect sustained operational emphasis rather than a short-term fluctuation.

There are notable payment patterns in the claims data: several procedure lines show high claim counts with low per-claim payments (for example D0120 4.9K claims at $6 avg paid/claim and D1120 4.3K claims at $10 avg paid/claim), consistent with high-throughput, low-unit-rate Medicaid reimbursement for routine pediatric services. Analysts should consider that revenue drivers are quantity-sensitive under these rates when modeling growth or sensitivity to utilization changes.

A small but present restorative component exists alongside the dominant preventive mix: codes like D2392 ($8.4K) and D2391 ($6.5K) contribute measurable but smaller shares of revenue (4.9% and 3.8% respectively), indicating the provider performs some posterior composite restorations in addition to preventive care. This mix suggests a general dentistry practice with a clear operational tilt toward prevention for younger populations.

There are several codes with claims but zero paid amounts listed (for example D9230: 613 claims, $0 avg paid/claim, $0 revenue and D9995: 16 claims, $0 avg paid/claim, $0 revenue). These zero-dollar lines are data features worth flagging for billing-adjudication review or further inquiry into how certain services are being coded, bundled, or reimbursed under state Medicaid rules.

Medicaid: Complete Services Breakdown

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

20 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D1120	Prophylaxis–child	4,300	$10	$43K
D0120	Periodic oral evaluation - established patient	4,860	$10	$29.2K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	2,310	$10	$20.7K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	1,380	$10	$16.6K
D0330	N/A	1,030	$10	$10.3K
D1208	Topical application of fluoride - excluding varnish	3,200	$1	$9.6K
D2392	Post 2 surface resin‑based composite	380	$20	$8.4K
D2391	Resin‑based composite – one surface, posterior	470	$10	$6.5K
D0272	N/A	1,580	$1	$6.3K
D1351	Sealant - per tooth	670	$10	$4.7K

Showing 1–10 of 20

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Armed Forces Pacific Distribution

Rachel Anderson — 8 of 18 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Armed Forces Pacific

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

20 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D0120	Periodic oral evaluation - established patient	1	10	1,660	$30	$52.3K
D1120	Prophylaxis–child	1	10	1,740	$20	$36.8K
D2392	Post 2 surface resin‑based composite	4	10	390	$60	$30.6K
D1351	Sealant - per tooth	2	10	520	$30	$16.5K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	1	10	360	$20	$13.4K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	1	10	1,080	$10	$13.3K
D0274	N/A	3	10	710	$10	$12.9K
D0272	N/A	1	10	920	$10	$8.1K
D2391	Resin‑based composite – one surface, posterior	1	10	200	$30	$7.4K
D1208	Topical application of fluoride - excluding varnish	1	10	630	$10	$7.1K

Showing 1–10 of 20

Rachel Anderson — Billing Profile & Reimbursement Data

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Rachel Anderson — 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

Frequently Asked Questions

References