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

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

Pediatric Dentistry PC (NPI 1861818668)

Field	Value
Entity Type	Organization
Organization	Pediatric Dentistry PC
Address	3116 Saddle Dr
City	Helena
State	MT
ZIP	59601
Taxonomy	Pediatric Dentistry
NPI Enumerated	March 17, 2014

Payer Source	Total Paid
Medicaid	$9.9M
Medicare	$0

Key Findings

This provider is effectively a single-payer Medicaid practice: there is no Medicare billing on file and all reported lifetime federal revenue comes from Medicaid ($9.9M). That payer concentration means operational performance and revenue are closely tied to Medicaid enrollment and reimbursement policies rather than Medicare dynamics.

A small set of codes drives a large share of Medicaid revenue — the top three codes (D2930, D1120, D1206) account for 39.4% of this provider's Medicaid revenue. Specifically, D2930 generated $1.6M (16.0%), D1120 generated $1.2M (12.8%), and D1206 generated $1M (10.6%), indicating revenue concentration in a mix of high-frequency preventive and high-value procedure codes.

The code mix is characteristic of a high-volume pediatric dentistry operation: preventive services dominate the top lines with D1120 (D1120 – Prophylaxis–child) showing 37.7K claims and D1206 (Topical Fluoride Treatment) showing 51.5K claims, and sealants (D1351) also appearing high at 26.5K claims. These large counts for child-focused prophylaxis, fluoride, and sealants point to a practice model built around routine preventive care and early-intervention services for children.

Competitive standing within the state is strong for core pediatric codes: D1206 ranks #2 of 259 providers in-state (100th percentile; extreme outlier) and D1120 ranks #2 of 180 providers (99th percentile; extreme outlier), while D2930 ranks #2 of 23 providers (95th percentile; notably above typical state volume). Across numerous other codes the provider also appears in the top percentiles (for example D0120 at 99th percentile and D1351 at 98th percentile), signaling that this practice is one of the major pediatric dental players in Montana for both preventive and restorative services.

The practice also bills a range of restorative and surgical codes in material amounts, indicating comprehensive pediatric services rather than only screenings: D2930 produced $1.6M (16.0%), D2392 produced $382.9K (3.9%), and D7140 (extractions) produced $450.1K (4.6%). These entries, together with a high rank for D1330 and presence of D3220 and D2929, suggest routine in-office restorative and extraction capacity alongside the high-volume preventive work.

There is limited but notable billing for adult prophylaxis (D1110): 7.6K claims yielded $350.2K (3.6% of Medicaid revenue) and the provider ranks #6 of 270 in-state (98th percentile). While pediatric services dominate, this indicates some treatment of older adolescents or adults, broadening the clinical mix modestly beyond strictly child-only codes.

The practice has been active for an established period: the NPI was enumerated on 2014-03-17 (~12 years ago). That tenure is consistent with the high cumulative claims counts (tens of thousands for top preventive codes) and statewide top-percentile rankings observed across multiple service lines.

Concentration risk and operational leverage are both evident: with $9.9M total Medicaid revenue and 39.4% of that revenue coming from the top three codes, any material reimbursement or policy change affecting D2930, D1120, or D1206 could meaningfully affect revenue. Conversely, the provider's top-state rankings and extreme outlier status on key pediatric prevention codes give it clear scale and visibility with Medicaid payers and managed care plans within Montana.

Medicaid: Complete Services Breakdown

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

38 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D2930	N/A	13,030	$120	$1.6M
D1120	Prophylaxis–child	37,750	$30	$1.2M
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	51,500	$20	$1M
D0120	Periodic oral evaluation - established patient	34,660	$20	$831.9K
D1310	N/A	19,570	$40	$704.4K
D1351	Sealant - per tooth	26,520	$20	$636.5K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	6,520	$70	$450.1K
D1330	N/A	19,570	$20	$410.9K
D2392	Post 2 surface resin‑based composite	3,270	$120	$382.9K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	7,610	$50	$350.2K

Showing 1–10 of 38

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

Pediatric Dentistry PC — 15 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

38 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D2930	N/A	2	20	2,090	$120	$493.4K
D8080	N/A	7	10	80	$2,020	$436K
D8670	N/A	23	30	4,310	$80	$432.6K
D8070	N/A	3	10	50	$2,270	$218.1K
D2392	Post 2 surface resin‑based composite	16	130	310	$120	$173.4K
D9248	N/A	9	20	530	$140	$150.4K
D2929	N/A	3	10	400	$190	$126.3K
D1310	N/A	2	50	520	$40	$119.6K
D1351	Sealant - per tooth	2	60	590	$30	$101.4K
D1120	Prophylaxis–child	2	180	200	$30	$88.4K

Showing 1–10 of 38

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
West Mont	MT	Adult Care Home Facility	$0	$34.7M
Intermountain Deaconess Home	MT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$11.9M
County Of Lewis & Clark Lewis & Clark County School District #1	MT	Local Education Agency (LEA)	$0	$10.8M
Montana Children's Home & Hospital	MT	General Acute Care Hospital	$0	$8.7M
Region Iv Family Outreach, Inc	MT	Case Manager/Care Coordinator	$0	$7.3M
Lewis And Clark Emergency Physicians P C	MT	Emergency Medicine Physician	$0	$6.6M
Montana Independent Living Project	MT	In Home Supportive Care Agency	$0	$6M
St. Peter's Health	MT	Family Medicine Physician	$0	$5.2M
Edgewood Helena Senior Living LLC	MT	Assisted Living Facility	$0	$4.7M
Montana Surgery Center	MT	Ambulatory Surgical Clinic/Center	$0	$4.6M

Pediatric Dentistry PC — Billing Profile & Reimbursement Data

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Pediatric Dentistry PC — 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