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

Why is the Medicaid comparison limited to North Dakota 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 Dakota (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.

Spectra Health (NPI 1689878324)

Field	Value
Entity Type	Organization
Organization	Spectra Health
Address	212 S 4th St
City	Grand Forks
State	ND
ZIP	58201
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	June 14, 2007

Payer Source	Total Paid
Medicaid	$5.5M
Medicare	$0

Key Findings

SPECTRA HEALTH appears to operate primarily as a dental-focused Federally Qualified Health Center: the top Medicaid revenue drivers are dental procedure codes (512, D0120, D0140) and additional restorative and extraction codes (D2392, D7140, D2391), indicating the organization’s principal service line is dental care rather than medical services. The dominance of preventive and limited/comprehensive oral evaluations suggests routine primary dental care for a Medicaid population, with restorative and extractions as secondary volume drivers.

Medicaid revenue is the sole payer stream on file: the provider has no Medicare billing on record and reports Total Medicaid revenue of $5.5M. This makes SPECTRA HEALTH effectively a single-payer (Medicaid) billing entity in the available dataset, concentrating its reimbursement exposure and operational focus on Medicaid-covered dental services.

Revenue concentration is high in a small set of codes: the precomputed top-3 Medicaid codes by revenue account for 81.0% of the provider’s total Medicaid revenue, with code 512 alone representing $2.9M (52.7% of Medicaid revenue). This indicates that a few high-volume dental procedure lines drive the bulk of the organization’s financials, increasing sensitivity to reimbursement or utilization changes for those specific codes.

Code 512 is the single biggest revenue driver and the provider is the leading in-state reporter for that code: 13.3K claims generated $2.9M and rank #1 of 2 providers in-state (100th percentile). That concentration and top rank within a small in-state peer group mark SPECTRA HEALTH as a primary provider of whatever service 512 denotes in GRAND FORKS and suggest local market reliance on this site for that procedure.

Several preventive and common diagnostic dental codes show unusually high volume relative to state peers: D0120 (5.6K claims, $924.3K, 97th percentile) and D0140 (3.6K claims, $641.5K, 95th percentile) both rank well above typical state volumes, indicating the clinic delivers a high throughput of routine dental evaluations compared with most in-state providers. These percentile labels — described in the source as "notably above typical" — support characterization of SPECTRA HEALTH as a major preventive dental access point for Medicaid enrollees.

There are multiple codes with very high claim counts but recorded $0 average paid/claim (for example D0220, D0274, D0330, D1206, D1351). These items appear as extreme outliers or high-volume zero-revenue line items in the dataset and may reflect non-billed encounters, bundled/reimbursed differently, or reporting artifacts; regardless, they inflate claim volumes for radiographs and preventive procedures without contributing to reported Medicaid revenue.

Competitive standing across dental codes is mixed but skewed toward leadership for specific services: SPECTRA HEALTH ranks in the 90th+ percentiles for many top codes (e.g., D0120 at 97th, D0140 at 95th, D0150 at 93rd), showing it is a high-volume in-state provider for core dental evaluations, while for some restorative codes it is a top-4 or top-5 participant, indicating strong but not exclusive market share in those services.

Provider tenure is long-established: the NPI was enumerated on 2007-06-14 (approximately 19 years ago), suggesting sustained operation and continuity of billing relationships with Medicaid over nearly two decades, which supports the observed high cumulative Medicaid revenue and entrenched role in local dental service delivery.

Medicaid: Complete Services Breakdown

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

24 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
512	Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures without CC/MCC	13,290	$220	$2.9M
D0120	Periodic oral evaluation - established patient	5,600	$170	$924.3K
D0140	Limited oral evaluation – problem focused	3,600	$180	$641.5K
D0150	Comprehensive oral evaluation – new or established patient	2,180	$150	$333.4K
D2392	Post 2 surface resin‑based composite	2,090	$130	$267.1K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	1,930	$100	$200.3K
D2391	Resin‑based composite – one surface, posterior	1,520	$120	$186.5K
D1120	Prophylaxis–child	3,310	$10	$19.9K
D2393	Resin-based composite, three surfaces, posterior	140	$110	$15K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	3,630	$1	$10.9K

Showing 1–10 of 24

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Dakota Distribution

Spectra Health — 5 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Dakota

Full comparison — all codes billed, vs. North Dakota median

24 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
512	Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures without CC/MCC	1	10	6,670	$220	$1.5M
D2392	Post 2 surface resin‑based composite	4	40	130	$110	$83.4K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	4	20	300	$90	$76.2K
D2391	Resin‑based composite – one surface, posterior	4	30	100	$90	$63.3K
D1120	Prophylaxis–child	8	80	360	$40	$48.3K
D0120	Periodic oral evaluation - established patient	5	120	350	$40	$46.8K
D1351	Sealant - per tooth	5	30	470	$20	$46.6K
D0140	Limited oral evaluation – problem focused	3	40	100	$70	$44K
D9230	N/A	9	20	280	$30	$29.9K
D0150	Comprehensive oral evaluation – new or established patient	5	60	250	$50	$27K

Showing 1–10 of 24

Related Providers

Other providers that share a Tax Identification Number (TIN) with Spectra Health, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spectra Health	ND	Federally Qualified Health Center (FQHC)	$0	$3.2M
Spectra Health	ND	Federally Qualified Health Center (FQHC)	$0	$258.6K
Anne Nygaard	ND	Family Nurse Practitioner	$44.6K	$0
Kristen Young	ND	Family Nurse Practitioner	$730	$0
Lisa Bernhardt	ND	Adult Health Clinical Nurse Specialist	$470	$0
David Sundberg	ND	Primary Care Nurse Practitioner	$220	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Development Homes Inc	ND	Community/Behavioral Health Agency	$0	$53.9M
Altru Health System	ND	Clinic/Center	$0	$29.7M
Altru Health System	ND	General Acute Care Hospital	$0	$18.7M
L.i.s.t.e.n. Inc	ND	Community/Behavioral Health Agency	$0	$9.4M
Peterson Medical Clinics, LLC	ND	Multi-Specialty Clinic/Center	$0	$8.8M
Edgewood Sartell LLC	ND	Assisted Living Facility	$0	$7.1M
Northeast Behavioral Health Clinic	ND	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$6.7M
Little Miracles, Inc.	ND	Multi-Specialty Clinic/Center	$0	$5.5M
Anil Potti	ND	Hematology & Oncology Physician	$4.9M	$0
Valley Oral & Facial Surgery PC	ND	Oral and Maxillofacial Surgery Clinic/Center	$0	$4.5M

Spectra Health — Billing Profile & Reimbursement Data

Sign up for Spectra Health — Billing Profile & Reimbursement Data policy alerts

Spectra Health — Billing Profile & Reimbursement Data

Sign up for Spectra Health — Billing Profile & Reimbursement Data policy alerts

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