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

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

Rafael Rivera, Jr., Dds, PLLC (NPI 1740459650)

Field	Value
Entity Type	Organization
Organization	Rafael Rivera, Jr., Dds, PLLC
Address	2041 Silas Creek Pkwy
City	Winston Salem
State	NC
ZIP	27103
Taxonomy	Dentist
NPI Enumerated	February 25, 2008

Payer Source	Total Paid
Medicaid	$22.1M
Medicare	$0

Medicaid: Complete Services Breakdown

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

44 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D2930	N/A	19,480	$150	$2.8M
D0120	Periodic oral evaluation - established patient	87,320	$30	$2.3M
D1120	Prophylaxis–child	60,100	$30	$1.6M
D2140	Amalgam - one surface, primary or permanent	20,910	$70	$1.5M
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	38,350	$40	$1.5M
D3220	N/A	16,100	$80	$1.3M
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	81,530	$20	$1.3M
D2934	N/A	5,710	$190	$1.1M
D2150	Amalgam - two surfaces, primary or permanent	11,100	$90	$1M
D1351	Sealant - per tooth	32,780	$30	$917.9K

Showing 1–10 of 44

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Rafael Rivera, Jr., Dds, PLLC — 18 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

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

44 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D7240	N/A	39	100	600	$190	$454.1K
D2930	N/A	8	260	710	$140	$426.8K
D2392	Post 2 surface resin‑based composite	310	940	660	$100	$205.2K
D7230	N/A	10	60	500	$160	$204.5K
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation; includes related cutting of gingiva and bone, removal of tooth structure, minor smoothing of…	318	330	330	$100	$165.8K
D2140	Amalgam - one surface, primary or permanent	1	60	70	$70	$130.4K
D9230	N/A	112	460	800	$40	$127.7K
D9243	N/A	4	40	140	$130	$118.5K
D0120	Periodic oral evaluation - established patient	4	1,440	1,210	$30	$116.6K
D1120	Prophylaxis–child	8	1,140	780	$30	$116.3K

Showing 1–10 of 44

Related Providers

Other providers that share a Tax Identification Number (TIN) with Rafael Rivera, Jr., Dds, PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rafael Rivera, Jr., Dds, PLLC	NC	Dentist	$0	$19.1M
Rafael Rivera, Jr., Dds, PLLC	NC	Dentist	$0	$17.8M
Rafael Rivera, Jr., Dds, PLLC	NC	Dentist	$0	$16.4M
Rafael Rivera, Jr, Dds, PLLC	NC	Dentist	$0	$14.8M
Rafael Rivera, Jr., Dds, PLLC	NC	Dentist	$0	$14.2M
Rafael Rivera, Jr., Dds, PLLC	NC	Dentist	$0	$14M
Rafael Rivera, Jr, Dds, PLLC	NC	Dentist	$0	$8.6M

Nearby Providers

Other providers in the same ZIP code as Rafael Rivera, Jr., Dds, PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Forsyth Memorial Hospital, Inc.	NC	General Acute Care Hospital	$0	$40.9M
Bayada Home Health Care, Inc.	NC	Home Health Agency	$0	$39.5M
Bayada Home Health Care, Inc.	NC	Developmental Disabilities Clinic/Center	$0	$35.4M
Bayada Home Health Care, Inc.	NC	Home Health Agency	$0	$34.4M
Bayada Home Health Care, Inc.	NC	Home Health Agency	$0	$21M
A Bridge To Achievement Nc, LLC	NC	Community/Behavioral Health Agency	$0	$15.6M
Nevaeh & Company LLC	NC	Customized Equipment (DME)	$0	$12.1M
Speechcenter LLC, D/b/a Sidekick Therapy Partners	NC	Speech-Language Pathologist	$0	$10.8M
Champion Family Healthcare Services, LLC	NC	Home Health Agency	$0	$9.9M
Winston-salem Forysth County Schools	NC	Local Education Agency (LEA)	$0	$9.1M

Rafael Rivera, Jr., Dds, PLLC — Billing Profile & Reimbursement Data

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Rafael Rivera, Jr., Dds, PLLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References