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

Why is the Medicaid comparison limited to Delaware 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. Delaware (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.

Coastal Kids Pediatric Dentistry, LLC (NPI 1821433145)

Field	Value
Entity Type	Organization
Organization	Coastal Kids Pediatric Dentistry, LLC
Address	18947 John J Williams Hwy
City	Rehoboth Beach
State	DE
ZIP	19971
Taxonomy	Pediatric Dentistry
NPI Enumerated	April 30, 2013

Payer Source	Total Paid
Medicaid	$9.7M
Medicare	$0

Key Findings

This provider is effectively single‑payer: there is no Medicare billing on file while lifetime Medicaid revenue totals $9.7M. The absence of Medicare claims indicates the practice’s clinical and revenue footprint is concentrated on Medicaid‑enrolled pediatric patients rather than Medicare populations.

Revenue is concentrated in a small set of codes: D2930 ($1.7M, 17.4%), D1120 ($1.3M, 13.3%), and D0120 ($879.4K, 9.0%) together account for 39.7% of the provider’s Medicaid revenue. That level of concentration means a few high-volume pediatric/preventive encounters are driving a large share of total Medicaid receipts.

The code mix indicates a pediatric preventive and routine restorative practice: very high volumes of D1120 (Prophylaxis–child), D0120 (Periodic oral evaluation), D1206 (Topical Fluoride) and D1351 (Sealant) point to a strong focus on well‑child preventive visits, while material revenue from D7140 (extractions) and posterior composite codes (D2392, D2391) shows the clinic also delivers significant basic restorative and surgical care for children under Medicaid.

Competitively, the provider is a major in‑state pediatric Medicaid participant for core preventive services — D1120 ranks #4 of 116 (97th percentile, labeled 'extreme outlier'), D0120 ranks #5 of 158 (97th percentile, 'extreme outlier'), and D1206 ranks #4 of 128 (98th percentile, 'extreme outlier'). These rank/percentile positions characterize the clinic as a high-volume, above‑typical provider in Delaware for those service lines.

Claim counts signal substantial throughput: D1206 shows 25K claims, D1120 24K claims, D0120 20.9K claims and D2930 6.6K claims, reflecting frequent preventive visits and procedures billed to Medicaid. Those volumes are consistent with either a multi‑chair pediatric practice or a high-visit cadence and are important for capacity, utilization, and network planning.

There are notable code-level reporting patterns with many claims producing no paid revenue — for example D0603 has 24.1K claims with $0 avg paid/claim and ranks #3 of 87 in-state (98th percentile), and D9420 shows 769 claims with $0 paid. High-volume, $0-paid line items suggest administrative or public‑health reporting, alternative payment pathways, or non‑fee‑for‑service activity that do not contribute to the $9.7M Medicaid revenue total.

Revenue concentration creates exposure to Medicaid policy shifts: because the practice reports $9.7M entirely from Medicaid and the top three codes account for 39.7% of Medicaid revenue, changes in Medicaid coverage, reimbursement, or utilization for pediatric preventive/restorative codes could materially affect overall revenue. Analysts should flag this payer and code concentration when assessing financial and network risk.

The NPI has been enumerated since 2013-04-30 (~13 years ago), indicating an established presence in the market. Combined with top statewide ranks on multiple pediatric codes, this tenure supports the view that the provider is a long‑standing, prominent Medicaid pediatric dental provider in Rehoboth Beach, DE.

Medicaid: Complete Services Breakdown

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

27 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D2930	N/A	6,610	$260	$1.7M
D1120	Prophylaxis–child	24,020	$50	$1.3M
D0120	Periodic oral evaluation - established patient	20,940	$40	$879.4K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	25,010	$30	$800.4K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	4,650	$160	$743.7K
D1351	Sealant - per tooth	17,140	$40	$702.9K
D2392	Post 2 surface resin‑based composite	2,490	$230	$583.6K
D2391	Resin‑based composite – one surface, posterior	2,350	$180	$428.4K
D0272	N/A	11,800	$40	$424.7K
D9230	N/A	4,780	$70	$348.9K

Showing 1–10 of 27

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

Coastal Kids Pediatric Dentistry, LLC — 7 of 22 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

27 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D2930	N/A	2	30	580	$260	$446.8K
D2392	Post 2 surface resin‑based composite	19	90	490	$220	$366.3K
D1351	Sealant - per tooth	6	70	1,690	$40	$217.1K
D2391	Resin‑based composite – one surface, posterior	10	70	320	$180	$192K
D1120	Prophylaxis–child	4	120	960	$50	$163.3K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	3	60	270	$140	$137K
D9230	N/A	4	30	900	$70	$121.1K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	4	130	1,220	$30	$116.9K
D0120	Periodic oral evaluation - established patient	5	160	800	$40	$110.5K
D3220	N/A	2	10	260	$180	$90K

Showing 1–10 of 27

Nearby Providers

Other providers in the same ZIP code as Coastal Kids Pediatric Dentistry, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Beacon Pediatrics LLC	DE	Pediatrics Physician	$0	$3.7M
Ams Of Delaware, LLC	DE	Substance Use Disorder Rehabilitation Hospital Unit	$123.6K	$3.3M
Nouman Asif	DE	Hematology & Oncology Physician	$1.5M	$0
Delaware Eye Surgery Center, LLC	DE	Ambulatory Surgical Clinic/Center	$1.3M	$20.1K
Charles Curry	DE	Ophthalmology Physician	$605.3K	$0
Rehoboth Beach Volunteer Fire Co., Inc.	DE	Ambulance	$459.2K	$62.8K
Scott Fudemberg	DE	Ophthalmology Physician	$353.5K	$0
Arthur Belson	DE	Ophthalmology Physician	$316.3K	$0
Matthew Tulloch	DE	Family Medicine Physician	$257K	$0
Laurie Conti	DE	Optometrist	$203.8K	$44.9K

Coastal Kids Pediatric Dentistry, LLC — Billing Profile & Reimbursement Data

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Coastal Kids Pediatric Dentistry, LLC — Billing Profile & Reimbursement Data

Sign up for Coastal Kids Pediatric Dentistry, LLC — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References