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

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

Darren Boles Dds PLLC (NPI 1922526813)

Field	Value
Entity Type	Organization
Organization	Darren Boles Dds PLLC
Address	1 Place Notre Dame
City	St Johnsbury
State	VT
ZIP	05819
Taxonomy	Dental Clinic/Center
NPI Enumerated	August 31, 2017

Payer Source	Total Paid
Medicaid	$5.2M
Medicare	$0

Key Findings

This provider is effectively a single-payer Medicaid practice: there is no Medicare billing on file and total reported Medicaid revenue is $5.2M. The absence of Medicare activity indicates the provider’s clinical and business footprint is concentrated on the Medicaid population rather than a mixed Medicare/Medicaid panel.

Revenue is concentrated in a small set of dental services: D4341 ($648.4K, 13.2% of Medicaid revenue), D2392 ($642.5K, 13.1%), and D2393 ($284.1K, 5.8%) — the precomputed top three codes together account for 32.0% of this provider’s Medicaid revenue. Those three codes alone drive roughly one-third of Medicaid revenue, signaling reliance on a defined set of restorative and periodontal procedures.

The code mix points to a combined preventive/restorative periodontal practice model. High-volume preventive and diagnostic codes (D1206, D1351, D0120, D1120) coexist with significant restorative and periodontal procedures (D2392, D2393, D4341), suggesting the operation provides routine pediatric/adult preventive care alongside more complex restorative and periodontal treatment.

Claim volumes show a high-throughput, high-volume Medicaid operation: preventive codes such as D1206 (15.5K claims), D1351 (14.3K claims), and D0120 (11.9K claims) have very large claim counts, while restorative codes like D2392 (5.4K claims) and D2393 (1.9K claims) also appear at scale. This mix of many low-unit-value preventive visits and substantial volumes of restorative encounters is consistent with a clinic serving a large Medicaid patient panel.

The provider is a dominant statewide performer for several specific codes: D4341 ranks #1 of 7 providers in-state (100th percentile; notably above typical state volume for this code), D2393 ranks #1 of 30 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code), and D1351 ranks #1 of 37 providers in-state (100th percentile; notably above typical state volume for this code). Multiple additional codes also sit in high percentiles (for example D0230 #1 of 27, 100th percentile; extreme outlier), indicating market leadership in particular services within Vermont’s Medicaid network.

At the same time, the provider is not uniformly dominant across all common dental services: D1110 (4.8K claims, $204.7K revenue) ranks #12 of 150 providers in-state (93th percentile; typical, unremarkable volume for this code) and D7140 (1.4K claims, $122.1K revenue) ranks #13 of 45 (73th percentile; typical, unremarkable volume). This pattern indicates niche dominance in certain periodontal/restorative codes while maintaining ordinary participation in other routine adult services.

Payer-rate and unit-value patterns reflect a blend of high-volume, low-paid preventive care and lower-volume, higher-paid restorative/periodontal care: examples include D1206 ($18 avg paid/claim), D1351 ($15 avg paid/claim) on the preventive side versus D2393 ($149 avg paid/claim), D2392 ($120 avg paid/claim) and D4341 ($119 avg paid/claim) for restorative/periodontal services. That split amplifies the clinic’s financial sensitivity to shifts in utilization of a relatively small set of higher-paying codes.

The practice has an established presence: NPI enumerated on 2017-08-31 (~9 years ago), and sustained high-volume Medicaid billing across preventive, restorative, and periodontal codes suggests operational stability and an entrenched role in the state Medicaid dental ecosystem.

Medicaid: Complete Services Breakdown

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

47 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D4341	Periodontal scaling and root planing - four or more teeth per quadrant	5,450	$120	$648.4K
D2392	Post 2 surface resin‑based composite	5,350	$120	$642.5K
D2393	Resin-based composite, three surfaces, posterior	1,910	$150	$284.1K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	15,460	$20	$278.3K
D0120	Periodic oral evaluation - established patient	11,920	$20	$274.1K
D2391	Resin‑based composite – one surface, posterior	2,760	$80	$223.7K
D1351	Sealant - per tooth	14,310	$20	$214.6K
D4346	N/A	3,740	$60	$212.9K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	4,760	$40	$204.7K
D4342	N/A	1,980	$100	$192.2K

Showing 1–10 of 47

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Vermont Distribution

Darren Boles Dds PLLC — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. Vermont median

47 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	8	20	770	$140	$185K
D2392	Post 2 surface resin‑based composite	5	60	610	$130	$155.6K
D4342	N/A	1	10	1,270	$100	$127.8K
D4341	Periodontal scaling and root planing - four or more teeth per quadrant	1	10	90	$120	$107.7K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	13	50	400	$80	$101.1K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	12	150	540	$50	$73.5K
D1351	Sealant - per tooth	1	40	480	$20	$63.9K
D2391	Resin‑based composite – one surface, posterior	4	50	310	$90	$62.9K
D7880	N/A	2	10	150	$410	$59.9K
D9230	N/A	13	20	500	$50	$59.7K

Showing 1–10 of 47

Nearby Providers

Other providers in the same ZIP code as Darren Boles Dds PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Baart Behavioral Health Services, Inc.	VT	Substance Use Disorder Rehabilitation Clinic/Center	$559K	$3.5M
Northern Counties Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$3.4M
Northeastern Vermont Regional Hospital, Inc	VT	Primary Care Clinic/Center	$0	$2.8M
Northern Counties Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$2.5M
Caledonia-essex Area Ambulance Service, Inc.	VT	Land Ambulance	$406.4K	$1.6M
Northern Counties Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$1.8M
Northeastern Vermont Regional Hospital, Inc	VT	Rural Health Clinic/Center	$0	$1.3M
Northern Counties Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$1.3M
Jason Parks	VT	Radiation Oncology Physician	$1.2M	$0
Shippee Family Eye Care PC	VT	Optometrist	$0	$1M

Darren Boles Dds PLLC — Billing Profile & Reimbursement Data

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Darren Boles Dds PLLC — 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