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

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

Northwestern Band Of The Shoshone (NPI 1841856986)

Field	Value
Entity Type	Organization
Organization	Northwestern Band Of The Shoshone
Address	984 S 500 W Ste 3
City	Brigham City
State	UT
ZIP	84302
Taxonomy	General Practice Physician
NPI Enumerated	May 14, 2019

Payer Source	Total Paid
Medicaid	$8.5M
Medicare	$0

Key Findings

This provider effectively operates as a single‑payer Medicaid participant: there is no Medicare billing on file and total Medicaid revenue is $8.5M, indicating Medicaid is the sole recorded source of fee‑for‑service income in the available data. Analysts should treat this entity as Medicaid‑centric when modelling payer exposure or network value.

Revenue is highly concentrated in a very small set of dental procedure codes: the precomputed top‑3 Medicaid codes account for 77.8% of the provider’s Medicaid revenue, with a single code, D0140, contributing $5.4M (62.9% of Medicaid revenue). This degree of concentration signals that a narrow set of services drives most of the practice’s cash flow.

The service mix is dominated by dental evaluations and diagnostics: the largest revenue code is D0140 (Limited oral evaluation – problem focused), supported by high volumes of imaging (D0220 – periapical) and comprehensive evaluation (D0150). Complementary restorative and preventive codes present in the top 25 (for example D2150, D2392, D1110, D7140) indicate the operation functions as a dental clinic providing both problem‑driven visits and some restorative care rather than a broad primary‑care practice. Note the listed taxonomy is General Practice Physician, which contrasts with the dental procedure mix and may warrant verification for network contracting or credentialing purposes.

This provider is a dominant statewide outlier for problem‑focused dental evaluations: D0140 ranks #1 of 260 providers in‑state (100th percentile; extreme outlier, far above typical state volume for this code), making it a primary source of that particular Medicaid service in Utah. The combination of rank and revenue share suggests competitive leverage in that specific service line for state Medicaid carve‑outs or dental program planning.

The provider shows above‑typical volumes for related diagnostic and exam codes: D0150 (comprehensive oral evaluation) produced $606.7K and ranks #15 of 419 providers in‑state (97th percentile; notably above typical state volume), while D0220 (periapical first image) produced $662.8K and ranks #35 of 436 providers in‑state (92th percentile; typical, unremarkable volume). Together these ranks reinforce that evaluations and dental imaging are core activity areas and not incidental.

Outside the top three, the remaining high‑value codes are spread across routine exams, restorations, and extractions (examples include D0120, D2150, D2392, D1110, D7140). Most of those codes sit at typical in‑state percentiles, although D0274 is noted at the 97th percentile (notably above typical state volume) and D1110 is at the 96th percentile (notably above typical), indicating pockets of above‑average preventive or imaging workload.

From an operational inference perspective, the predominance of D0140 over D0150 suggests a workflow weighted toward episodic/problem‑driven encounters rather than routine preventive scheduling; the presence of prophylaxis codes (D1110, D1120) and sealants (D1351) shows some preventive care, but these generate far smaller revenue shares. Analysts evaluating capacity, appointment mix, or utilization management should plan for a high proportion of urgent/problem visits.

The provider’s NPI was enumerated on 2019‑05‑14 (~7 years ago), establishing a relatively recent but multi‑year presence in the state Medicaid market. That tenure, combined with the extreme outlier status on D0140, suggests the site has rapidly built a specialized Medicaid dental volume footprint that may be important for state program access and network adequacy assessments.

Medicaid: Complete Services Breakdown

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

30 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D0140	Limited oral evaluation – problem focused	11,800	$460	$5.4M
D0220	Intraoral - periapical first radiographic image	4,540	$150	$662.8K
D0150	Comprehensive oral evaluation – new or established patient	1,810	$340	$606.7K
D0120	Periodic oral evaluation - established patient	1,090	$350	$382.6K
D2150	Amalgam - two surfaces, primary or permanent	1,310	$280	$361.3K
D2392	Post 2 surface resin‑based composite	840	$200	$166.2K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	1,730	$90	$148.7K
D2391	Resin‑based composite – one surface, posterior	300	$380	$113.7K
D2740	N/A	280	$360	$98.2K
D0230	Intraoral - periapical each additional radiographic image	2,950	$30	$97.2K

Showing 1–10 of 30

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Utah Distribution

Northwestern Band Of The Shoshone — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. Utah median

30 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D0120	Periodic oral evaluation - established patient	156	470	460	$80	$149.8K
D4341	Periodontal scaling and root planing - four or more teeth per quadrant	5	10	650	$160	$120.1K
D2740	N/A	6	20	60	$490	$110.3K
D1351	Sealant - per tooth	121	190	620	$30	$60.7K
D0140	Limited oral evaluation – problem focused	1	260	140	$120	$55.8K
D2150	Amalgam - two surfaces, primary or permanent	42	220	290	$60	$45K
D2392	Post 2 surface resin‑based composite	27	170	170	$80	$39.4K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	53	150	170	$60	$35.9K
D4355	N/A	5	10	80	$130	$34.5K
D0220	Intraoral - periapical first radiographic image	35	440	470	$20	$32.8K

Showing 1–10 of 30

Nearby Providers

Other providers in the same ZIP code as Northwestern Band Of The Shoshone, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Brigham City Community Hospital, Inc.	UT	General Acute Care Hospital	$0	$5.8M
Beecon Recovery Inc	UT	Substance Use Disorder Rehabilitation Clinic/Center	$0	$3.8M
Brigham City Corporation	UT	Land Ambulance	$209.1K	$1.9M
Box Elder School District Preschool	UT	Local Education Agency (LEA)	$0	$1.4M
Advantage Medical Supply, Inc.	UT	Oxygen Equipment & Supplies (DME)	$0	$915.1K
Medical Arts Center Clinic Of Brigham City Inc	UT	Family Medicine Physician	$0	$826.8K
Brigham Medical Clinic, Inc.	UT	Family Medicine Physician	$0	$460.2K
Scott Turner	UT	Specialist	$451.9K	$0
Apex Youth Services Excel	UT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$345.3K
Lynn Larsen	UT	Nurse Practitioner	$203K	$0

Northwestern Band Of The Shoshone — 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