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

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

Dakota Eye Institute PC (NPI 1962449835)

Dakota Eye Institute PC is a ophthalmology physician provider located in Bismarck, North Dakota. This profile covers 0 Medicare and 10 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Dakota Eye Institute PC
Address	200 S 5th St
City	Bismarck
State	ND
ZIP	58504
Taxonomy	Ophthalmology Physician
NPI Enumerated	June 1, 2006

Payer Source	Total Paid
Medicaid	$1.2M
Medicare	$0

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

10 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
92012	For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…	6,200	$80	$477K
92015	The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced.	14,850	$20	$252.4K
92340	Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal	4,720	$30	$155.7K
92002	The provider performs an intermediate level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program.	1,650	$80	$128.8K
J0178	Injection, aflibercept, 1 mg	80	$790	$61K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	970	$50	$44.6K
92134	The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes.	1,110	$20	$24.4K
67028	The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye.	240	$60	$15.6K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	190	$50	$10K
92004	The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.	10	$160	$2.2K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Dakota Distribution

Dakota Eye Institute PC — 4 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Dakota

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

10 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	70	210	360	$100	$498.2K
J0178	Injection, aflibercept, 1 mg	3	10	130	$1,100	$172.1K
92012	For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…	1	20	150	$100	$100.3K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	21	50	160	$80	$66.4K
67028	The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye.	8	10	350	$90	$61.2K
92004	The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.	35	40	70	$100	$35.9K
92002	The provider performs an intermediate level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program.	1	10	240	$70	$23.8K
92134	The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes.	6	10	1,110	$10	$21.9K
92015	The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced.	2	80	370	$10	$21.5K
92340	Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal	1	40	220	$30	$17.2K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Braden Burckhard	CA	Retina Specialist (Ophthalmology) Physician	$1.8M	$0
Dakota Surgery & Laser Center LLC	ND	Ambulatory Surgical Clinic/Center	$1.7M	$28.4K
Elena Raducu	ND	Ophthalmology Physician	$1.1M	$0
Paul Selid	ND	Ophthalmology Physician	$860.8K	$0
Reid Mollman	ND	Ophthalmology Physician	$757K	$0
Aaron Fortney	ND	Ophthalmology Physician	$561.1K	$0
Andrew Rodenburg	ND	Ophthalmology Physician	$373.3K	$0
Jennifer Hoggarth	ND	Certified Registered Nurse Anesthetist	$97.8K	$0
Cynthia Roles	ND	Optometrist	$46.7K	$0
Paul Balliet	ND	Optometrist	$39.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pride Inc.	ND	Developmentally Disabled Services Day Training Agency	$0	$71.1M
Sanford Bismarck	ND	Multi-Specialty Clinic/Center	$0	$43.9M
Support Systems, Inc.	ND	Community/Behavioral Health Agency	$0	$37.7M
Bridging The Dental Gap Inc	ND	Dental Clinic/Center	$0	$6.8M
Pride Inc	ND	Community/Behavioral Health Agency	$0	$6.6M
Pride Inc.	ND	Community/Behavioral Health Agency	$0	$5.7M
Pride Inc	ND	Community/Behavioral Health Agency	$0	$4.9M
The Kid's Therapy Center LLC	ND	Community/Behavioral Health Agency	$0	$1.5M
City Of Bismarck	ND	State or Local Public Health Clinic/Center	$111.3K	$1.3M
Derik Hoerner, Dds, PC	ND	Dentist	$0	$1.1M

Dakota Eye Institute PC — Billing Profile & Reimbursement Data

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Dakota Eye Institute PC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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